Glycocalyx Components in Prognosis of Sepsis - A Commentary

Abstract

Objectives: Endothelial glycocalyx shedding has been recognized as a contributor in sepsis pathophysiology. Hence, we attempted to analyse hyaluronan and syndecan (glycocalyx components) as markers of morbidity and prognosis of sepsis by performing serial measurements in these patients. Design and methods:Subjects were community acquired sepsis, severe sepsis and septic shock patients (150) admitted to ICU of our tertiary care hospital and controls were 50 healthy volunteers. Serum concentrations of markers were measured on days 1,3,5,7 of ICU admission. Survival was assessed after 90 days. Statistical analysis was performed by SPSS version 17.Results: Hyaluronan and syndecan levels were significantly elevated in all categories of sepsis patients as compared to controls (p<0.001). Levels of both markers were increased in severe sepsis and septic shock patients as compared to sepsis patient group at all-time points. Hyaluronan and syndecan differentiated survivors from non survivors (p<0.001). Unlike non-survivors, in the survivor group, median hyaluronan and syndecan levels decreased significantly (p<0.001) in subsequent measurements. ROC analysis for the prediction of mortality identified cut-offs of 441 ng/ml and 898 ng/ml for hyaluronan and syndecan, respectively. The specificity and negative predictive values were 90% and 90% for hyaluronan and 86% and 91% for syndecan, respectively. Kaplan Meier curves revealed similar results. Both markers correlated significantly with APACHE II and SOFA scores. Conclusion:These observations indicate that serial measurements of hyaluronan and syndecan are significant prognostic markers for morbidity and survival in sepsis. Further, therapeutic interventional possibilities need to be explored in experimental interventional prospective multi-centre trials.