Abstract
Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. Disruption of the endothelial glycocalyx contributes to acute lung injury in sepsis, but has not been well studied in H1N1 influenza. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza. This prospective observational study included 53 patients with influenza A (H1N1) during the influenza season, and 30 healthy controls in our hospital. Patients were grouped by severity and survival. We collected clinical data and blood samples at admission. Inflammatory factors (tumor necrosis factor-α, interleukin-6, interleukin-10) and endothelial glycocalyx components (syndecan-1, hyaluronan, heparan sulfate) were measured. The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. Syndecan-1 and hyaluronan were positively correlated with disease severity, which was indicated by the APACHE II and SOFA scores and lactate levels, and negatively correlated with albumin levels. At a cutoff point ≥ 173.9 ng/mL, syndecan-1 had a 81.3% sensitivity and 70.3% specificity for predicting of 28-day mortality. Kaplan–Meier analysis demonstrated a strong association between syndecan-1 levels and 28-day mortality (log-rank 11.04, P = 0.001). Elevated plasma levels of syndecan-1 has a potential role in systemic organ dysfunction and may be indicative of disease severity in patients with influenza A (H1N1).
Highlights
Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood
We found that plasma levels of SDC-1 and HA were significantly higher in patients with severe H1N1 than in patients with mild H1N1, and were positively correlated with the APACHE II and Sequential Organ Failure Assessment (SOFA) scores
Plasma glycocalyx component levels are significantly higher in patients with severe influenza A (H1N1) than in mild cases
Summary
Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza This prospective observational study included 53 patients with influenza A (H1N1) during the influenza season, and 30 healthy controls in our hospital. The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. Elevated plasma levels of syndecan-1 has a potential role in systemic organ dysfunction and may be indicative of disease severity in patients with influenza A (H1N1). Benatti et al. reported that a higher level of HA and SDC-1 in flu syndromes with the ARDS group is observed compared to those without ARDS These findings suggest that endothelial glycocalyx shedding occurs during the virus-induced ARDS installation. The effect of the components of the glycocalyx on the prediction disease severity of influenza A (H1N1) needs to be further investigated
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