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

2021; BioMed Central; Volume: 25; Issue: 1 Linguagem: Inglês

10.1186/s13054-021-03545-1

1466-609X

Arianna Piotti, Deborah Novelli, Jennifer Marie Theresia Anna Meessen, Daniela Ferlicca, Sara Coppolecchia, Antonella Marino, Giovanni Salati, M. Savioli, Giacomo Grasselli, Giacomo Bellani, Antonio Pesenti, Serge Masson, Pietro Caironi, Luciano Gattinoni, Marco Gobbi, Claudia Fracasso, Roberto Latini, P. Bruzzone, Francesca Pagan, R Russo, A Confalonieri, Chiara Abbruzzese, Beatrice Vergnano, Stefano Faenza, Antonio Daniele Pinna, Elisabetta Pierucci, Andrea Noto, Angelo Pezzi, P. Spanu, Vieri Parrini, R Oggioni, G Pasetti, Maria Cinzia Casadio, Rosa Buontempo, Sara Carrer, Francesca Piccoli, Tatiana Rizzi, Anselmo Caricato, Monica La Sala, Alessandra Antonaci, Paola Fassini, Silvia Paganini, Virginia Porta, G Moise, Silvia Marell, Mirella Furia, Maria Cristina Urbano, Roberta Carobbi, Simona Poleni, Hassan Kandil, Andrea Ballotta, F Bettini, Manlio Sanseverino, Alessandro Gatta, Francesca Cecchini, Luca Guatteri, Gabriella Ciceri, Ferdinando Raimondi, Roberto Colombo, S Ferraris, Massimo Borelli, Vittoria Bellato, F Cancellieri, Silvia Senni, Ester Bertocchi, Paola Ferri, Gianpietro Moioli, Andrea Fedele, Alexandra Molin, Giovanni Salati, Pierpaolo Salsi, Emanuela Brunori, Daniele Elisei, Giuseppe Maggio, Federico Nicola, Marco Cavana, Giacomo Morelli, Arturo Guarino, Michele Isetta, G Tulli, Valerio Mangani, Nicola De Rossi, Marta Ferrari, Francesco Bona, Monica Vay, Teresa Bartoli, Mauro Gallo, K. Vettoretto, Mauro Della Morte, Enrico Boselli, Daniela Puscio, Monia Bovo, António Galzerano, Manuela Carli, G Zagara,

Sphingolipid Metabolism and Signaling

Abstract Background Septic 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. Methods This 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. Results Plasma 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. Conclusion Circulating 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.