ENDOTHELIAL GLYCOCALYX DAMAGE IN PATIENTS WITH SEVERE FUNCTIONAL INJURY

Abstract

In modern medical science, endothelial glycocalyx, which is considered a target organ in many diseases, including severe traumatic injuries, is becoming one of the main objects of researchers' attention [1,2]. Trauma is the leading cause of death and disability worldwide, and despite the introduction of damage-controlled resuscitation, mortality remains very high. More than half of trauma patients are found to have laboratory-defined coagulopathy on admission, which further leads to increased mortality [3,4]. Laboratory-defined coagulopathy, also called trauma-induced coagulopathy, is described as either excessive activation of the protein C pathway accompanied by hyperfibrinolysis or as a manifestation of the hemorrhagic phenotype of disseminated intravascular coagulation. Common to both of these explanations is that, they are based on the measurement of concentrations of pro- and anticoagulant clotting factors, platelet counts, and fibrin degradation products [5,6]. Nowadays, evidence is accumulating for a key role of the glycocalyx as one of the first structures involved in the trauma-induced coagulopathic response and it may be one of the earliest signs of progression in the severity of patients. In our study of trauma patients using whole blood thrombelastography (TEG), we found that the hemostatic profile became increasingly hypocoagulative and hyperfibrinolytic with increasing severity of injury, Therefore, studies of the significance of glycocalyx in the development of severe complications in conditions of persistently high lethality in trauma patients [7,8], are a priority and primary task of science and practical health care. Glycocalyx is a birth of a new clinical paradigm, but the full understanding of its significance and functions is still far away and researchers are only at the beginning of the way. We study the role of the endothelial glycocalyx system and analyze the relationship between markers of glycocalyx degradation and the severity of the clinical course of the disease in severe traumatic injuries. It is expected that a deeper study of the glycocalyx, understanding the relationship between the mechanisms of its degradation and trauma is extremely important and will lead to the development of new scientific strategies for early diagnosis and the possibility of predicting disease outcomes in patients with severe traumatic injuries. The object of our scientific research were patients with severe combined trauma. The study was carried out taking into account the principles of evidence-based medicine. The obtained data were processed using standard methods of statistical analysis.