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ENDOTHELIAL GLYCOCALYX SHEDDING IN INTRA-ABDOMINAL SEPSIS: A FEASIBILITY STUDY
Samuel P Carmichael1, Rachel D Appelbaum2, Antonio Renaldo3
1Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Shock (Augusta, Ga.)
|January 10, 2023
Summary
Elevated endothelial glycocalyx layer (EGL) biomarkers in plasma and tissue correlate with sepsis severity and resuscitation needs. This study shows EGL biomarker levels in both circulation and tissues can indicate patient status in intra-abdominal sepsis.
Area of Science:
- Vascular Biology and Endothelial Function
- Sepsis Pathophysiology
- Biomarker Discovery and Validation
Background:
- The endothelial glycocalyx layer (EGL) is crucial for vascular endothelium protection.
- Shedding of EGL biomarkers like hyaluronic acid (HA) and syndecan-1 (SDC-1) in plasma is linked to poor outcomes.
- The relationship between circulating EGL biomarkers and tissue-level EGL injury remains unclear.
Purpose of the Study:
- To establish a feasible method for collecting plasma and tissue samples to quantify EGL components in surgical patients with intra-abdominal sepsis.
- To compare EGL biomarker levels between tissue and plasma.
- To determine if EGL shedding in circulation and/or tissues correlates with clinical outcomes.
Main Methods:
- Prospective, observational, single-center feasibility study involving 15 adult patients with intra-abdominal sepsis.
- Collection of blood and resected tissue samples (pathologic and unaffected peritoneum) during surgery and 24-48 hours post-surgery.
- Quantification of HA and SDC-1 in tissue (CD138 stain) and plasma (ELISA), followed by pairwise comparisons and correlation analyses with clinical status and outcomes.
Main Results:
- Elevated circulating HA and SDC-1 correlated positively with postoperative Sequential Organ Failure Assessment (SOFA) scores and weakly with resuscitation volumes.
- Syndecan-1 levels in resected pathologic tissue significantly correlated with SOFA scores across all time points (R = 0.69, P < 0.0001).
- Both tissue and circulating EGL biomarkers correlated positively with SOFA scores > 6, indicating potential as indicators of resuscitative needs.
Conclusions:
- Elevations in both circulating and tissue EGL biomarkers correlate with postoperative SOFA scores, with tissue biomarkers showing stronger correlations.
- Tissue and circulating EGL biomarkers are positively correlated at higher SOFA scores (SOFA > 6).
- The study demonstrates the feasibility of sample procurement for EGL biomarker analysis, suggesting their potential as indicators of resuscitative needs in sepsis, though larger studies are warranted.
