Decreased endothelial glycocalyx thickness is an early predictor of mortality in sepsis

Danielle M. H. Beurskens, Martine E. Bol*, Tammo Delhaas, Marcel C. G. van de Poll, Chris P. M. Reutelingsperger, Gerry A. F. Nicolaes, Jan-Willem E. M. Sels

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

19 Citations (Web of Science)

Abstract

Microcirculatory alterations play an important role in the early phase of sepsis. Shedding of the endothelial glycocalyx is regarded as a central pathophysiological mechanism causing microvascular dysfunction, contributing to multiple organ failure and death in sepsis. The objective of this study was to investigate whether endothelial glycocalyx thickness at an early stage in septic patients relates to clinical outcome. We measured the perfused boundary region (PBR), which is inversely proportional to glycocalyx thickness, of sublingual microvessels (5-25 mm) using sidestream dark field imaging. The PBR in 21 patients with sepsis was measured within 24 h of admission to the intensive care unit (ICU). In addition, we determined plasma markers of microcirculatory dysfunction and studied their correlation with PBR and mortality. Endothelial glycocalyx thickness in sepsis was significantly lower for non-survivors as compared with survivors, indicated by a higher PBR of 1.97 [1.85, 2.19]mm compared with 1.76 [1.59, 1.97] mm, P = 0.03. Admission PBR was associated with hospital mortality with an area under the curve of 0.778 based on the receiver operating characteristic curve. Furthermore, PBR correlated positively with angiopoietin-2 (rho=0.532, P = 0.03), indicative of impaired barrier function. PBR did not correlate with Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Sequential Organ Failure Assessment score (SOFA score), lactate, syndecan-1, angiopoietin-1 or heparin-binding protein. An increased PBR within the first 24 h after ICU admission is associated with mortality in sepsis. Further research should be aimed at the pathophysiological importance of glycocalyx shedding in the development of multi-organ failure and at therapies attempting to preserve glycocalyx integrity.

Original languageEnglish
Pages (from-to)221-228
Number of pages8
JournalAnaesthesia and Intensive Care
Volume48
Issue number3
DOIs
Publication statusPublished - May 2020

Keywords

  • Sepsis
  • haemodynamic monitoring
  • intensive care
  • microcirculation
  • imaging modalities
  • multiple organ dysfunction
  • SUBLINGUAL MICROVASCULAR GLYCOCALYX
  • HEPARIN-BINDING PROTEIN
  • ORGAN FAILURE
  • MICROCIRCULATION
  • SYNDECAN-1
  • DAMAGE
  • INFLAMMATION
  • DYSFUNCTION
  • DIMENSIONS
  • BIOMARKERS

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