Endocan, sepsis, pneumonia, and acute respiratory distress syndrome

Abstract

Acute respiratory distress syndrome (ARDS) and hospital-acquired pneumonia (HAP) are major problems of public health in intensive care units (ICUs), occurring in 15% of critically ill patients. Among the factors explaining ARDS development, sepsis is known as a frequent cause. Sepsis, ARDS, and HAP increase morbidity, mortality, length of stay in the ICU, and the overall costs of healthcare. The major challenge remains to identify accurately among critically ill patients those at risk of poor outcomes who could benefit from novel therapies. Endocan is released by the pulmonary endothelium in response to local or systemic injury. It inhibits mainly leukocyte diapedesis rather than leukocyte rolling or adhesion to the endothelial cells both in vitro and in vivo. Endocan was evaluated in 25 clinical reports, including 2454 critically ill patients and 452 healthy controls. The diagnostic value of endocan for sepsis or sepsis severity was equal to procalcitonin but its prognostic value was better. A predictive value for postoperative pneumonia was evidenced in two studies, and a predictive value for ARDS in four studies from three independent centers. This review presents an overview of the structure, expression, and functions of endocan. We also hereby summarize the potential applications of endocan in the prediction and prognosis of ARDS and HAP, as well as in the prognosis of sepsis.

ESM-1 Levels and ARDS Prediction Score for Predicting ARDS Occurrence in Sepsis Patients

“…Through binary logistic regression analysis, it was found that ESM-1, CRP and IL-6 amounts on Day 1 were independently associated with ARDS occurrence in sepsis patients. ROC curve analysis showed that Day 1's plasma ESM-1 (AUC = 0.75) was superior to CRP (AUC = 0.736) and IL-6 (AUC = 0.736) in predicting the occurrence of ARDS within 72 hours, in agreement with De Freitas et al [26] .With a cutoff plasma ESM-1 levels of 5.865 ng/mL, the sensitivity and speci city of this parameter were 0.786 and 0.583, respectively, in predicting ARDS occurrence in sepsis patients. The accuracy in predicting ARDS occurrence was relatively high, with a low rate of missed diagnosis.…”

“…These experimental data con rmed that low plasma ESM-1 levels in sepsis patients may be associated with ARDS occurrence. It is generally admitted [26,27] that ESM-1 secreted by endothelial cells protects lung injury by reducing the adhesion of white blood cells to endothelial cells. ESM-1 can bind to LFA-1 to prevent its interaction with ICAM-1.…”

Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae

“… 31 Sepsis generally initiates a systemic inflammatory response, and proinflammatory cytokines, such as tumor necrosis factor alpha, interleukin 1 beta (IL-1β), IL-6, and IL-8, 32 , 33 are released. These cytokines activate neutrophils to produce toxic mediators and damage the endothelium and alveolar epithelium, 34 – 36 eventually leading to alveolar–capillary barrier injury. 30 , 37 Then, the protein-rich fluid induces acute pulmonary edema and inactivates PS.…”

Reliability of biomarkers of sepsis during extracorporeal therapies: the clinician needs to know what is eliminated and what is not

“…Endocan is a diagnostic and prognostic biomarker for sepsis and acute respiratory distress syndrome [9]. CRRT with a membrane cut-off of 35 kDa is unlikely to remove endocan (MW 40 kDa), but removal may possibly occur by adsorption when HAMs are used [10].…”