Endothelial damage in septic shock patients as evidenced by circulating syndecan-1, sphingosine-1-phosphate and soluble VE-cadherin: a substudy of ALBIOS

Critical Care

Sara Coppolecchia¹  Antonella Marino²  Pietro Caironi³  Luciano Gattinoni⁴  Arianna Piotti⁵  Claudia Fracasso⁵  Marco Gobbi⁵  Jennifer Marie Theresia Anna Meessen⁶  Deborah Novelli⁶  Serge Masson⁶  Roberto Latini⁶  Monica Savioli⁷  Antonio Pesenti⁷  Giacomo Grasselli⁷  Daniela Ferlicca⁸  Giacomo Bellani⁹  Giovanni Salati^1,10 

[1] Anestesia E Rianimazione, ISMETT IRCCS, Palermo, Italy;Anestesia III Terapia Intensiva Adulti, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy;Department of Anesthesiology and Critical Care, AOU S. Luigi Gonzaga, Orbassano, Italy;Department of Oncology, Università Degli Studi Di Torino, Turin, Italy;Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Gӧttingen, Gӧttingen, Germany;Department of Biochemistry and Molecular Pharmacology, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy;Department of Cardiovascular Medicine, Mario Negri Institute for Pharmacological Research IRCCS, Via Mario Negri 2, 20156, Milan, Italy;Dipartimento Di Anestesia, Rianimazione Ed Emergenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;Emergency Department, Ospedale San Gerardo, Monza, Italy;Emergency Department, Ospedale San Gerardo, Monza, Italy;Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy;UOC Anestesia E Rianimazione, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;

关键词: Septic shock;    Biomarker;    Glycocalyx;    Syndecan-1;    Sphingosine-1-phosphate;    VE-cadherin;   

DOI  :  10.1186/s13054-021-03545-1

来源: Springer

【 摘 要 】

BackgroundSeptic shock is characterized by breakdown of the endothelial glycocalyx and endothelial damage, contributing to fluid extravasation, organ failure and death. Albumin has shown benefit in septic shock patients. Our aims were: (1) to identify the relations between circulating levels of syndecan-1 (SYN-1), sphingosine-1-phosphate (S1P) (endothelial glycocalyx), and VE-cadherin (endothelial cell junctions), severity of the disease, and survival; (2) to evaluate the effects of albumin supplementation on endothelial dysfunction in patients with septic shock.MethodsThis was a retrospective analysis of a multicenter randomized clinical trial on albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis Trial, ALBIOS). Concentrations of SYN-1, S1P, soluble VE-cadherin and other biomarkers were measured on days 1, 2 and 7 in 375 patients with septic shock surviving up to 7 days after randomization.ResultsPlasma concentrations of SYN-1 and VE-cadherin rose significantly over 7 days. SYN-1 and VE-cadherin were elevated in patients with organ failure, and S1P levels were lower. SYN-1 and VE-cadherin were independently associated with renal replacement therapy requirement during ICU stay, but only SYN-1 predicted its new occurrence. Both SYN-1 and S1P, but not VE-cadherin, predicted incident coagulation failure. Only SYN-1 independently predicted 90-day mortality. Albumin significantly reduced VE-cadherin, by 9.5% (p = 0.003) at all three time points.ConclusionCirculating components of the endothelial glycocalyx and of the endothelial cell junctions provide insights into severity and progression of septic shock, with special focus on incident coagulation and renal failure. Albumin supplementation lowered circulating VE-cadherin consistently over time.Clinical Trial Registration: ALBIOS ClinicalTrials.gov number NCT00707122.

【 授权许可】

CC BY