title: Syndecan-1 in Acute Decompensated Heart Failure--Association With Renal Function and Mortality.
abstract: BACKGROUND
  Heart failure (HF) is a leading cause of hospitalization throughout the world, and the mortality rate remains elevated. HF is frequently complicated by acute kidney injury (AKI), worsening the patient's prognosis. There have been no studies evaluating the role that endothelial glycocalyx damage plays in HF patients and its association with AKI and mortality.
  
  
  RESULTS
  We measured several endothelial biomarkers in 201 consecutive patients with acute decompensated HF (ADHF) during emergency department (ED) admission. In-hospital mortality, AKI development and 6-month mortality rates were assessed. ADHF patients with worsening renal function had higher levels of syndecan-1 but not those patients with stable chronic kidney disease. Syndecan-1 levels during ED admission were predictive for AKI during the hospital stay (AUC 0.741, P<0.001) and had an even better discriminatory capacity in more severe AKI (AUC 0.812, P<0.001). Additionally, after adjusting for several confounding factors, including biomarkers of endothelial function and endothelial cell activation, syndecan-1 remained associated with in-hospital mortality rates. On a Cox multivariate analysis regression, syndecan-1 was associated with 6-month mortality rates.
  
  
  CONCLUSIONS
  The concentration of syndecan-1, a marker of glycocalyx damage measured during ED admission, is valuable in assessing the risk of developing AKI and in-hospital mortality. Its association with mortality is strong after 6-month follow-up.
authors.affiliation: Medical Sciences Post-graduate Program, Department of Clinical Medicine, Federal University of Ceará
authors.forename: Fernanda Macedo de Oliveira
authors.initials: FM
authors.lastname: Neves
authors.forename: Gdayllon Cavalcante
authors.initials: GC
authors.lastname: Meneses
authors.forename: Nazareth Ermínia Araujo
authors.initials: NE
authors.lastname: Sousa
authors.forename: Ramon Róseo Paula Pessoa Bezerra de
authors.initials: RR
authors.lastname: Menezes
authors.forename: Marcelo Coelho
authors.initials: MC
authors.lastname: Parahyba
authors.forename: Alice Maria Costa
authors.initials: AM
authors.lastname: Martins
authors.forename: Alexandre Braga
authors.initials: AB
authors.lastname: Libório
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D053668:Syndecan-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C508241:SDC1 protein, human; D053668:Syndecan-1