Abstract
Syndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We investigated organ dysfunction associated with changing serum SDC-1 levels for early detection of organ dysfunction in critically ill patients. To evaluate the effect of SDC-1 on laboratory parameters measured the day after SDC-1 measurement with consideration for repeated measures, linear mixed effects models were constructed with each parameter as an outcome variable. A total of 94 patients were enrolled, and 831 samples were obtained. Analysis using mixed effects models for repeated measures with adjustment for age and sex showed that serum SDC-1 levels measured the day before significantly affected several outcomes, including aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CRE), blood urea nitrogen (BUN), antithrombin III, fibrin degradation products, and D-dimer. Moreover, serum SDC-1 levels of the prior day significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Additionally, increasing serum SDC-1 level was a significant risk factor for mortality. Serum SDC-1 may be a useful biomarker for daily monitoring to detect early signs of kidney, liver and coagulation system dysfunction, and may be an important risk factor for mortality in critically ill patients.
Highlights
Syndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions
220 patients were excluded for the following reasons: under 18 years old (n = 17), discharged from the intensive care unit (ICU) within 72 h (n = 79), undergoing hemodiafiltration (n = 9), did not give consent to participate in the present study (n = 115)
Serum SDC-1 levels measured the day before laboratory parameter measurements had significant main effects on several outcomes including AST, alanine transaminase (ALT), T-Bil, CRE, blood urea nitrogen (BUN), fibrin degradation products (FDP) and antithrombin III (AT III), and showed a tendency towards having an effect on lactate dehydrogenase (LD) and D-dimer
Summary
Syndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. Systemic inflammatory conditions lead to endothelial dysfunction, which in turn increases paracellular permeability and the outflow of albumin/fluid into the interstitial s pace[5] This effect is thought to be caused by glycocalyx disruption. Several indicators have demonstrated that serum SDC-1 levels are significantly correlated with the Sequential Organ Failure Assessment (SOFA) score in patients with sepsis[22,23,24], and that non-survivors have significantly higher SDC-1 levels than survivors with sepsis[21,24,25] It remains unknown which organs show changing serum SDC-1 levels when damaged, and whether SDC-1 is a useful predictive marker for early detection of dysfunction in these organs. Years, median (IQR) Sex, male/female, n (%) Weight, kg, median (IQR) SOFA score on ICU admission, median (IQR) Condition, n (%) Trauma Myocardial infarction Sepsis Burn Heatstroke Heart failure Acute aortic dissection Ventricular fibrillation Soft tissue infection Hypoglycemia Other Source of sepsis, n (%) Klebsiella species Streptcoccus species Methicillin-susceptible Staphylococcus epidermidis Escherichia coli Unknown Length of ICU stay, days, median (IQR)
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