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Published on: November 8, 2024
Circulating Syndecan-1 Levels Are Associated with Chronological Coagulofibrinolytic Responses and the Development of
Hironori Matsumoto1, Suguru Annen1, Naoki Mukai1
1Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan.
Insights
High levels of circulating syndecan-1 (SDC-1) indicate endotheliopathy and are linked to severe coagulofibrinolytic responses after trauma. This elevation predicts the development of trauma-induced coagulopathy and disseminated intravascular coagulation (DIC).
Area of Science:
- Trauma research
- Hematology
- Vascular biology
Background:
- Trauma can trigger coagulofibrinolytic dysregulation, potentially leading to disseminated intravascular coagulation (DIC).
- Endotheliopathy, a dysfunction of the blood vessel lining, is implicated in these responses.
Purpose of the Study:
- To investigate the association between elevated circulating syndecan-1 (SDC-1) levels and coagulofibrinolytic responses in trauma patients.
- To determine if SDC-1 can predict the development of trauma-induced coagulopathy and DIC.
Main Methods:
- Retrospective analysis of 48 trauma patients.
- Assessment of SDC-1 and coagulofibrinolytic parameters over 7 days post-admission.
- Comparison of patient groups based on median SDC-1 levels on admission.
Main Results:
- Elevated SDC-1 levels were observed persistently for 7 days post-trauma.
- SDC-1 levels correlated significantly with markers of coagulation activation (TAT, AT), fibrinolysis (PIC, tPA).
- High SDC-1 was associated with prolonged coagulation activation, impaired anticoagulation, fibrinolytic activation, consumption coagulopathy, and increased transfusion needs, predicting DIC development (AUC=0.845).
Conclusions:
- High circulating syndecan-1 levels signify endotheliopathy in trauma patients.
- SDC-1 elevation is strongly associated with trauma-induced coagulopathy, characterized by intense coagulation activation, anticoagulation impairment, and fibrinolysis.
- Syndecan-1 serves as a potential biomarker for predicting DIC development following trauma.
Background:
The purpose of this study was to evaluate the association between endotheliopathy represented by high levels of circulating syndecan-1 (SDC-1) and coagulofibrinolytic responses due to trauma, which can lead to disseminated intravascular coagulation (DIC).
Methods:
We retrospectively evaluated 48 eligible trauma patients immediately admitted to our hospital and assessed SDC-1 and coagulofibrinolytic parameters for 7 days after admission. We compared the longitudinal changes of coagulofibrinolytic parameters and SDC-1 levels between two groups (high and low SDC-1) according to median SDC-1 value on admission.
Results:
The median circulating SDC-1 level was 99.6 (61.1-214.3) ng/mL on admission, and levels remained high until 7 days after admission. Coagulofibrinolytic responses assessed by biomarkers immediately after trauma were correlated with SDC-1 elevation (thrombin-antithrombin complex, TAT: r = 0.352, p = 0.001; antithrombin, AT: r = -0.301, p < 0.001; plasmin-α2-plasmin inhibitor complex, PIC: r = 0.503, p = 0.035; tissue plasminogen activator, tPA: r = 0.630, p < 0.001). Sustained SDC-1 elevation was associated with intense and prolonged coagulation activation, impairment of anticoagulation, and fibrinolytic activation followed by inhibition of fibrinolysis, which are the primary responses associated with development of DIC in the acute phase of trauma. Elevation of circulating SDC-1 level was also associated with consumption coagulopathy and the need for transfusion, which revealed a significant association between high SDC-1 levels and the development of DIC after trauma (area under the curve, AUC = 0.845, cut-off value = 130.38 ng/mL, p = 0.001).
Conclusions:
High circulating levels of syndecan-1 were associated with intense and prolonged coagulation activation, impairment of anticoagulation, fibrinolytic activation, and consumption coagulopathy after trauma. Endotheliopathy represented by SDC-1 elevation was associated with trauma induced coagulopathy, which can lead to the development of DIC.
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