Traumatic brain injury is associated with increased syndecan-1 shedding in severely injured patients

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Erika Gonzalez Rodriguez¹  Pär I. Johansson¹  Jessica C. Cardenas¹  Charles E. Wade¹  John B. Holcomb¹  Ryan S. Kitagawa²  Charles S. Cox³  Jakob Stensballe⁴ 

[1] Center for Translational Injury Research (CeTIR), Department of Surgery, McGovern Medical School, University of Texas Health Science Center;Department of Neurosurgery, Mischer Neuroscience Institute, McGovern Medical School at The University of Texas Health Science Center;Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center;Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet;

关键词: Endothelium;    Syndecan-1;    Traumatic endotheliopathy;    Sympathoadrenal activation;   

DOI  :  10.1186/s13049-018-0565-3

来源: DOAJ

【 摘 要 】

Abstract Introduction Head injury and exsanguination are the leading causes of death in trauma patients. Hemorrhagic shock triggers systemic endothelial glycocalyx breakdown, potentially leading to traumatic endotheliopathy (EoT). Levels of syndecan-1, a main glycocalyx component, have been used to assess the integrity of the glycocalyx. In TBI patients, it remains unclear whether syndecan-1 shedding occurs and its correlation with outcomes. We aimed to determine the frequency of EoT+, defined as a syndecan-1 level of 40 ng/ml or higher, after TBI in isolated and polytraumatic injury. We also investigated how the presence of EoT+ affected outcomes in TBI patients. Methods Severely injured trauma patients were enrolled. From blood samples collected upon patients’ arrival to the hospital, we measured syndecan-1 (main biomarker of EoT+), soluble thrombomodulin (sTM, endothelial activation) adrenaline and noradrenaline (sympathoadrenal activation), and assessed TBI patients’ coagulation capacity. Results Of the enrolled patients (n = 331), those with TBI and polytrauma (n = 68) had the highest rate of EoT+ compared to isolated TBI (n = 58) and Non-TBI patients (n = 205) (Polytrauma-TBI 55.9% vs. Isolated-TBI 20.0% vs. non-TBI polytrauma 40.0%; p = 0.001). TBI patients with EoT+ exhibited marked increases in sTM, adrenaline and noradrenaline levels, and physiological and coagulation derangements. In isolated TBI patients, increasing syndecan-1 levels (β for every 10 ng/ml increase: 0.14; 95% CI: 0.02, 0.26) and hypocoagulability were negatively associated with survival. Conclusions This study provides evidence of syndecan-1 shedding after TBI supporting the notion that breakdown of the glycocalyx contributes to the physiological derangements after TBI.

【 授权许可】

Unknown