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Plasma syndecan-1 is associated with fluid requirements and clinical outcomes in emergency department patients with sepsis

  • Jutamas Saoraya
    Affiliations
    Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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  • Lipda Wongsamita
    Affiliations
    Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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  • Nattachai Srisawat
    Affiliations
    Division of Nephrology, Department of Medicine, and Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Excellent Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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  • Khrongwong Musikatavorn
    Correspondence
    Corresponding author at: Department of Medicine, Faculty of Medicine, Chulalongkorn University, Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
    Affiliations
    Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

    Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Published:January 15, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.019

      Abstract

      Background

      Degradation of the endothelial glycocalyx is recognized as a major part of the pathophysiology of sepsis. Previous clinical studies, mostly conducted in intensive care settings, showed associations between glycocalyx shedding and clinical outcomes. We aimed to explore the association of plasma syndecan-1, a marker of glycocalyx degradation, with the subsequent fluid requirements and clinical outcomes of emergency department patients with sepsis.

      Methods

      This was a post hoc analysis of a randomized trial of fluid resuscitation in the emergency department. The study was conducted in the emergency department of an urban 1500-bed tertiary care center. The data of 95 adults who were diagnosed with sepsis-induced hypoperfusion and had undergone baseline syndecan-1 measurement were included. The syndecan-1 levels at baseline (T0) and hour 6 (T6) were studied to characterize their association with clinical outcomes, including subsequent fluid administration, organ failure outcomes and mortality.

      Results

      The median syndecan-1 levels at T0 and T6 were 207 (IQR 135–438) and 207 (IQR 128–490) ng/ml, respectively. Syndecan-1 levels at T0 were correlated with baseline sequential organ failure assessment (SOFA) score (ρ = 0.35, p < 0.001). Syndecan-1 levels at both T0 and T6 were correlated with subsequent fluid administration over 24 and 72 h and associated with the diagnosis of septic shock, the maximum dose of vasopressors and the need for renal replacement therapy (p < 0.05). Higher syndecan-1 levels at T6 were associated with higher 90-day mortality (p = 0.03).

      Conclusions

      In the emergency department, syndecan-1 levels were associated with fluid requirements, sepsis severity, organ dysfunction, and mortality.

      Keywords

      Abbreviations:

      ANP (Atrial natriuretic peptide), APACHE (Acute Physiology and Chronic Health Evaluation), ARDS (Acute respiratory distress syndrome), AUROC (Area under the receiver operating characteristic curve), BNP (Brain natriuretic peptide), ED (Emergency department), EDTA (Ethylenediaminetetraacetic acid), ELISA (Enzyme-linked immunosorbent assay), LRS (Lactated ringer's solution), ICU (Intensive care unit), MAP (Mean arterial pressure), NT-proBNP (N-terminal pro-b-type natriuretic peptide), OR (Odds ratio), qSOFA (Quick sequential organ failure assessment), RRT (Renal replacement therapy), SBP (Systolic blood pressure), SOFA (Sequential organ failure assessment), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)
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