A high admission syndecan-1 level, a marker of endothelial glycocalyx degradation, is associated with inflammation, protein C depletion, fibrinolysis, and increased mortality in trauma patients.

摘要: OBJECTIVE To investigate the association between markers of acute endothelial glycocalyx degradation, inflammation, coagulopathy, and mortality after trauma. BACKGROUND Hyperinflammation coagulopathy trauma predict increased mortality. High catecholamine levels can directly damage endothelium may be associated with enhanced evidenced by high circulating syndecan-1. METHODS Prospective cohort study patients admitted to a Level 1 Trauma Centre in 2003 2005. Seventy-five were selected blindly post hoc from 3 predefined injury severity score (ISS) groups ( 27). In all patients, we measured 17 tissue damage, natural anticoagulation, fibrinolysis (syndecan-1, IL-6, IL-10, histone-complexed DNA fragments, high-mobility group box (HMGB1), thrombomodulin, von Willebrand factor, intercellular adhesion molecule-1, E-selectin, protein C, factor pathway inhibitor (TFPI), antithrombin, D-dimer, tissue-type plasminogen activator (tPA), urokinase-type (uPA), soluble uPA receptor, inhibitor-1), hematology, coagulation, catecholamines, assessed 30-day Variables compared stratified according syndecan-1 median. RESULTS Patients had higher HMGB1, tPA, (all P < 0.05), 3-fold (42% vs. 14%, = 0.006) despite comparable ISS (P 0.351). Only degradation was correlated adrenaline, APTT, lower C unchanged TFPI blunted D-dimer response 0.001) because profoundly even at low ISS. After adjusting for age ISS, an independent predictor (OR: 1.01 [95%CI, 1.00-1.02]; 0.043). CONCLUSIONS syndecan-1, marker is