Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Surgery, Division of Acute Care Surgery, Nashville, Tennessee.
Shock. 2023 Apr 1;59(4):540-546. doi: 10.1097/SHK.0000000000002079. Epub 2023 Jan 10.
Background: The endothelial glycocalyx layer (EGL) is a complex meshwork of glycosaminoglycans and proteoglycans that protect the vascular endothelium. Cleavage or shedding of EGL-specific biomarkers, such as hyaluronic acid (HA) and syndecan-1 (SDC-1, CD138) in plasma, have been shown to be associated with poor clinical outcomes. However, it is unclear whether levels of circulating EGL biomarkers are representative of the EGL injury within the tissues. The objective of the present feasibility study was to describe a pathway for plasma and tissue procurement to quantify EGL components in a cohort of surgical patients with intra-abdominal sepsis. We sought to compare differences between tissue and plasma EGL biomarkers and to determine whether EGL shedding within the circulation and/or tissues correlated with clinical outcomes. Methods: This was a prospective, observational, single-center feasibility study of adult patients (N = 15) with intra-abdominal sepsis, conducted under an approved institutional review boards. Blood and resected tissue (pathologic specimen and unaffected peritoneum) samples were collected from consented subjects at the time of operation and 24-48 hours after surgery. Endothelial glycocalyx layer biomarkers (i.e., HA and SDC-1) were quantified in both tissue and plasma samples using a CD138 stain and ELISA kit, respectively. Pairwise comparisons were made between plasma and tissue levels. In addition, we tested the relationships between measured EGL biomarkers and clinical status and patient outcomes. Results: Fifteen patients with intra-abdominal sepsis were enrolled in the study. Elevations in EGL-specific circulating biomarkers (HA, SDC-1) were positively correlated with postoperative SOFA scores and weakly associated with resuscitative volumes at 24 hours. Syndecan-1 levels from resected pathologic tissue significantly correlated with SOFA scores at all time points ( R = 0.69 and P < 0.0001) and positively correlated with resuscitation volumes at 24 hours ( R = 0.41 and P = 0.15 for t = 24 hours). Tissue and circulating HA and SDC-1 positively correlated with SOFA >6. Conclusions: Elevations in both circulating and tissue EGL biomarkers were positively correlated with postoperative SOFA scores at 24 hours, with resected pathologic tissue EGL levels displaying significant correlations with SOFA scores at all time points. Tissue and circulating EGL biomarkers were positively correlated at higher SOFA scores (SOFA > 6) and could be used as indicators of resuscitative needs within 24 hours of surgery. The present study demonstrates the feasibility of tissue and plasma procurement in the operating room, although larger studies are needed to evaluate the predictive value of these EGL biomarkers for patients with intra-abdominal sepsis.
内皮糖萼层（EGL）是一种由糖胺聚糖和蛋白聚糖组成的复杂网状结构，可保护血管内皮。已有研究表明，血浆中 EGL 特异性生物标志物（如透明质酸（HA）和 syndecan-1（SDC-1，CD138））的裂解或脱落与不良临床结局相关。然而，目前尚不清楚循环 EGL 生物标志物的水平是否代表组织内的 EGL 损伤。本可行性研究的目的是描述一种从接受腹部手术的腹腔脓毒症患者中定量评估 EGL 成分的血浆和组织采集途径。我们旨在比较组织和血浆 EGL 生物标志物之间的差异，并确定循环和/或组织中 EGL 脱落是否与临床结局相关。方法：这是一项在机构审查委员会批准下进行的前瞻性、观察性、单中心可行性研究，纳入了 15 名患有腹腔脓毒症的成年患者。在手术时和手术后 24-48 小时，从同意的患者中采集血液和切除的组织（病理标本和未受影响的腹膜）样本。使用 CD138 染色和 ELISA 试剂盒分别定量组织和血浆样本中的内皮糖萼层生物标志物（即 HA 和 SDC-1）。对血浆和组织水平进行了两两比较。此外，我们还测试了测量的 EGL 生物标志物与临床状态和患者结局之间的关系。结果：本研究共纳入 15 名患有腹腔脓毒症的患者。特定于 EGL 的循环生物标志物（HA、SDC-1）的升高与术后 SOFA 评分呈正相关，与 24 小时时的复苏量呈弱相关。切除的病理组织中的 syndecan-1 水平与所有时间点的 SOFA 评分均呈显著相关（R = 0.69，P < 0.0001），与 24 小时时的复苏量呈正相关（R = 0.41，P = 0.15，t = 24 小时）。组织和循环中的 HA 和 SDC-1 与 SOFA >6 呈正相关。结论：循环和组织 EGL 生物标志物的升高均与术后 24 小时 SOFA 评分呈正相关，切除的病理组织 EGL 水平与所有时间点的 SOFA 评分均呈显著相关。组织和循环 EGL 生物标志物在较高的 SOFA 评分（SOFA > 6）时呈正相关，可作为术后 24 小时内复苏需求的指标。本研究证明了在手术室中进行组织和血浆采集的可行性，尽管需要更大规模的研究来评估这些 EGL 生物标志物对腹腔脓毒症患者的预测价值。
