title: Evolution of serum hyaluronan and syndecan levels in prognosis of sepsis patients.
abstract: OBJECTIVE
  Endothelial glycocalyx shedding has been recognized as a contributor in sepsis pathophysiology. Hence, we attempted to analyze hyaluronan and syndecan (glycocalyx components) as markers of morbidity and prognosis of sepsis by performing serial measurements in these patients.
  
  
  METHODS
  Subjects were community acquired sepsis, severe sepsis and septic shock patients (150) admitted to ICU of our tertiary care hospital and controls were 50 healthy volunteers. Serum concentrations of markers were measured on days 1, 3, 5, 7 of ICU admission. Survival was assessed after 90days. Statistical analysis was performed by SPSS version 17.
  
  
  RESULTS
  Hyaluronan and syndecan levels were significantly elevated in all categories of sepsis patients as compared to healthy controls (p<0.001). Levels of both markers were increased in severe sepsis and septic shock patients as compared to sepsis patient group at all time-points. Hyaluronan and syndecan differentiated survivors from non-survivors (p<0.001). Unlike non-survivors, in the survivor group, median hyaluronan and syndecan levels decreased significantly (p<0.001) in subsequent measurements. ROC analysis for the prediction of mortality identified cut-offs of 441ng/ml and 898ng/ml for hyaluronan and syndecan respectively. The specificity and negative predictive values were 90% and 90% for hyaluronan and 86% and 91% for syndecan respectively. Kaplan Meier curves revealed similar results. Both markers correlated significantly with APACHE II and SOFA scores.
  
  
  CONCLUSIONS
  These observations indicate that serial measurements of hyaluronan and syndecan are significant prognostic markers for morbidity and survival in sepsis. Future therapeutic interventional possibilities need to be explored in experimental interventional prospective multi-centric trials.
authors.affiliation: Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi 110060, India. Electronic address: dimplemicro85@gmail.com.
authors.forename: Dimple
authors.initials: D
authors.lastname: Anand
authors.affiliation: Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India. Electronic address: drsray67@yahoo.co.in.
authors.forename: Sumit
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi 110060, India. Electronic address: lalitmohan67@hotmail.com.
authors.forename: Lalit Mohan
authors.initials: LM
authors.lastname: Srivastava
authors.affiliation: Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi 110060, India. Electronic address: bhargavaseema6@gmail.com.
authors.forename: Seema
authors.initials: S
authors.lastname: Bhargava
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis*; D053667:Syndecans / Q000097:blood*
chemical_list: D015415:Biomarkers; D053667:Syndecans; D006820:Hyaluronic Acid; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Glycocalyx; Hyaluronan; Organ failure; Sepsis; Syndecan