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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 15, 2021
Accepted:
January 10,
2021
Received in revised form:
January 7,
2021
Received:
December 10,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
