Endothelial glycocalyx degradation is associated with acute lung injury and prognosis in septic patients

Abstract Background: The purpose of this study is to investigate the relationship between the extent of glycocalyx disruption and sepsis-induced acute lung injury.Methods: In total, 68 patients admitted to the department of critical care medicine of the hospital were enrolled between September 2020 to September 2021. The levels of serum syndecan1 were measured by enzyme-linked immunosorbent assay. Clinical parameters and standard laboratory test data were also recorded. Results: Serum syndecan1 levels within 24 h after ICU admission were significantly increased in the sepsis-induced acute lung injury(SALI) group compared with the sepsis non-acute lung injury(NSALI) group (97.12 ± 19.46 vs. 73.50 ± 16.52 ng/mL, p < 0.0001). Serum syndecan1 was moderately negatively correlated with oxygenation index (rs = - 0.593, p < 0.001) in all the patients. Moreover, multivariate logistic regression analysis indicated that syndecan1 was also independently associated with ALI risk( OR 0.896 (95% CI 0.836-0.961, p = 0.002). For the SALI diagnosis, the results indicated that syndecan1 (AUC 0.825 ± 0.053, p < 0.0001) was more valuable than other indicators. The AUC for syndecan1 level associated with 28 day mortality was 0.896 (95% CI, 0.817-0.974, p < 0.0001). Patients in the high-level syndecan1 group ( > 90.15 ng/mL) had significantly increased 28 day mortality compared with those in the low-level group ( < 90.15 ng/mL)[log-rank (Mantel-Cox), 14.82, p = 0.0001].Conclusions: serum syndecan1 within 24 h after ICU admission may be a useful biomarker to predict the incidence of SALI, additionally, elevated serum syndecan1 levels may be an important risk factor for mortality in septic patients.