Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

Feng Qi,Zhi-He Tang,Hao Zhou,Feng Li,Jin-Song Zhang,Peng Gu,Jian-Rong Chen,Bao-Feng Zhu

doi:10.1186/s12873-021-00446-y

Abstract

BackgroundEndothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients.MethodsA prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group.ResultsThere were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively.ConclusionsEG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

Highlights

Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness
The serum SDC1and heparin sulfate (HS) in trauma group were significantly higher compared with control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36]; 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24]; P < 0.001, respectively) (Table 1, Fig. 1)
Comparison within trauma group by different degree of degradation Trauma group was divided into high degradation groups (SDC1 ≥ median) and low degradation groups (SDC1 < medians) by SDC1 median (69.39 ng/ml), comparing the differences between the two sets

Summary

Introduction

Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. Organ function impairments are common in trauma, especially in polytrauma [3]. Endothelial glycocalyx (EG) is a layer of gel-like macromolecules widely distributed on the surface of vascular endothelium, mainly composed of proteoglycans (PGs) and glycosaminoglycans (GAGs). EG maintains vascular homeostasis by regulating vascular tension and permeability, inhibiting thrombosis in microvessels and regulating leukocyte adhesion on endothelial cell surface [6,7,8].Currently, EG abnormal degradations were widely detected in sepsis, tumor and other critical illness [9, 10]. Data of EG degradation in polytrauma patients, and the association with early organ function impairment are obscure. GAGs include HS, hyaluronic acid (HA) and dermatan sulfates, HS accounts for more than 50% of GAGs [12]

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Discussion

Conclusion