Syndecan-1 Levels and Early Positive Fluid Balance Are Associated with Disease Severity in Acute Pancreatitis.

Abstract

To study fluid balance and endothelial glycocalyx degradation, reflected by syndedan-1 and heparan sulfate (HS) levels, in early stages of acute pancreatitis (AP). This study comprised of 210 AP patients (104 mild, 53 moderately severe, 17 severe). Blood was sampled within 72 h from the onset of symptoms, and plasma syndecan-1 and HS levels were determined using ELISA. Fluid balance up to sampling and up to 4 days was determined retrospectively from medical records. Syndecan-1 levels predicted severe AP (SAP) in receiver operating characteristic analysis [area under curve 0.699, 95% confidence interval (CI) 0.546 to 0.851, p = 0.021]. Increasing AP severity was associated with higher intravenous fluid intake and lower urine output. In multivariate binary logistic regression analysis, positive fluid balance up to sampling [odds ratio (OR) 1.05 per 100 ml, 95% CI 1.02 to 1.11, p = 0.010] and higher APACHE-II score at sampling (OR 1.48, 95% CI 1.20 to 1.83, p < 0.001) were independently associated with severe AP, while syndecan-1 level was not. SAP is associated with high positive fluid balance in the early stages of treatment. Although increased in SAP, syndecan-1 was not independently associated with SAP when controlling for fluid balance and APACHE-II score.