title: Plasma syndecan-1 levels identify a cohort of patients with severe sepsis at high risk for intubation after large-volume intravenous fluid resuscitation.
abstract: Sepsis damages the endothelial glycocalyx, contributing to fluid extravasation, organ injury, and death. Our goal was to determine if syndecan-1 level is associated with the risk of intubation and modifying effect of intravenous fluids (IVFs) in these patients.
  
  
  
  Syndecan-1 was measured at enrollment in patients underdoing protocolized resuscitation for severe sepsis or septic shock. The primary outcome was difference in syndecan-1 based on subsequent intubation status, with in-hospital mortality and acute kidney injury serving as secondary outcomes. Logistic regression was performed to evaluate the effect of IVF volume on each outcome.
  
  
  
  Syndecan-1 was measured in 175 patients. Twenty-two percent met the primary outcome, 21% died, and 57% developed kidney injury. Syndecan-1 was nonsignificantly higher in intubated patients and was significantly higher in nonsurvivors and those with kidney injury. High syndecan-1 was defined as >240 ng/mL. The IVFs did not differ significantly between high and low syndecan-1 groups. Fluid volume was not associated with intubation in patients with a low syndecan-1 level but was associated with intubation in those with high syndecan-1 levels.
  
  
  
  Syndecan-1 is elevated in emergency department sepsis nonsurvivors. Patients with high syndecan-1 may represent a cohort at particular risk for intubation after large-volume fluid administration.
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Puskarich
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Cornelius
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Tharp
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Utsav
authors.initials: U
authors.lastname: Nandi
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA. Electronic address: aejones@umc.edu.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000628:therapy; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment; D018805:Sepsis / Q000097:blood / Q000628:therapy; D012772:Shock, Septic / Q000097:blood* / Q000628:therapy; D053668:Syndecan-1 / Q000097:blood*
chemical_list: D053668:Syndecan-1
keywords: Endothelium; Glycocalyx; Intravenous fluids; Risk stratification; Sepsis; Syndecan-1