Syndecan-1 as a severity biomarker for patients with trauma

Suzuki, Keiko; Okada, Hideshi; Sumi, Kazuyuki; Tomita, Hiroyuki; Kobayashi, Ryo; Ishihara, Takuma; Mizuno, Yosuke; Yamaji, Fuminori; Kamidani, Ryo; Miura, Tomotaka; Yasuda, Ryu; Kitagawa, Yuichiro; Fukuta, Tetsuya; Suzuki, Kodai; Miyake, Takahito; Kanda, Norihide; Doi, Tomoaki; Yoshida, Takahiro; Yoshida, Shozo; Tetsuka, Nobuyuki; Ogura, Shinji; Suzuki, Akio

doi:10.3389/fmed.2022.985955

Cited by 10 publications

(14 citation statements)

References 30 publications

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“…Syndecan-1 levels were higher in the isotrauma TBI group (SMD = 0.52; 95% CI = 0.03–1.00; I2 = 83%; P = 0.040), re-affirming previous findings that SDC-1 is elevated in trauma patients (23) (Fig. 2).…”

Section: Resultssupporting

confidence: 86%

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Clinical Value of Syndecan-1 Levels in Trauma Brain Injury: A Meta-Analysis

Xie,

Ding,

Bhandari

et al. 2023

Shock

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Background Traumatic brain injury (TBI) is a head trauma, usually associated with death and endothelial glycocalyx damage. Syndecan-1 (SDC-1)—a biomarker of glycocalyx degradation—has rarely been reported in meta-analyses to determine the clinical prognostic value in TBI patients. Methods We looked into PubMed, EMBASE, Cochrane Library, and Web of Science databases from January 01, 1990, to May 1, 2023, to identify eligible studies. A meta-analysis was conducted using RevMan 5.4 and Stata 16.0 with the search terms “SDC-1” and “traumatic brain injury”. Results The present study included five studies with a total of 640 enrolled patients were included. SDC-1 concentrations were higher in the Iso-trauma TBI group than in the non-TBI group [standardized mean difference (SMD) = 0.52; 95% CI: 0.03 – 1.00; P = 0.04]. Subgroup analysis revealed statistical significance when comparing the SDC-1 level of multi-trauma TBI (TBI + other injuries) group with the Iso-trauma TBI group (SMD = 0.74; 95% CI: 0.42–1.05; P < 0.001), and the SDC-1 level of the TBI coagulopathy (+) group (TBI with early coagulopathy) with the TBI coagulopathy (-) group (SMD =1.75; 95% CI:0.41–3.10; P = 0.01). Iso-trauma TBI patients with higher SDC-1 level were at a higher risk of 30-day in-hospital mortality [odds ratio (OR) =3.32; 95% CI: 1.67–6.60; P = 0.0006]. Conclusion This meta-analysis suggests that SDC-1 could be a biomarker of endotheliopathy and coagulopathy in TBI, as it was increased in iso-trauma TBI patients and was higher in multi-trauma TBI patients. There is a need for additional research into the use of syndecan-1 as a prognostic biomarker in TBI, especially in iso-trauma TBI patients.

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Section: Resultssupporting

confidence: 86%

“…Isotrauma TBI patients with higher SDC-1 level were at a higher risk of 30-day in-hospital mortality. This meta-analysis suggests that SDC-1 could be a biomarker of endotheliopathy and coagulopathy in TBI, a potential prognostic warning indicator for TBI, and re-affirmed previous findings that SDC-1 is elevated in trauma patients (23).…”

Section: Discussionsupporting

confidence: 87%

Clinical Value of Syndecan-1 Levels in Trauma Brain Injury: A Meta-Analysis

Xie,

Ding,

Bhandari

et al. 2023

Shock

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“…Multiple adult trauma studies have reported an association between syndecan-1 elevation and poor outcomes 22–24,35,36 . Gonzalez Rodriguez et al 22 reported a study of injured adults, defining a cutoff of 40 ng/mL as abnormal and comparing those with higher versus lower levels of syndecan-1; elevated levels were associated with higher injury severity as in this study, as well as mortality and the need for blood product transfusion.…”

Section: Discussionmentioning

confidence: 49%

“…[32][33][34] Multiple adult trauma studies have reported an association between syndecan-1 elevation and poor outcomes. [22][23][24]35,36 Gonzalez Rodriguez et al 22 reported a study of injured adults, defining a cutoff of 40 ng/mL as abnormal and comparing those with higher versus lower levels of syndecan-1; elevated levels were associated with higher injury severity as in this study, as well as mortality and the need for blood product transfusion. In a prospective study of 424 adult subjects, syndecan-1 was an independent predictor of <24-hour, 7-day, and 28-day mortality after controlling for other contributing factors including age, sex, ISS, Glasgow Coma Scale, base excess, platelet count, and hemoglobin.…”

Section: Discussionmentioning

confidence: 57%

Endotheliopathy of trauma in children: The association of syndecan-1 with injury and poor outcomes

Morgan,

Abou-Khalil,

Gaines

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children. METHODS This is a prospective cohort study of children (younger than 18 years) who presented with a potentially severe injury to an academic pediatric trauma center. Syndecan-1 level was collected on arrival and 24 hours following hospital arrival. Children were categorized as injured versus uninjured based on results of trauma evaluation. Demographics, injury characteristics, vital signs, and clinical laboratories were recorded. A composite clinical outcome was defined as death or blood product transfusion within 24 hours of hospital arrival. Statistical tests determined the impact of injury characteristics and therapeutics on syndecan-1 levels and assessed for associations between syndecan-1 level and outcomes. RESULTS A total of 121 subjects were included in the analysis: 96 injured (79%) and 25 uninjured (21%). There were no differences between groups in age (median [interquartile range (IQR)], 11 [4–14] years), sex, or race. The injured cohort had a median (IQR) Injury Severity Score of 16 (9–21), 75% had blunt mechanism, 26% were transfused within 6 hours, 3% had 24-hour mortality, and 6% had in-hospital mortality. Median (IQR) syndecan-1 level on admission was significantly higher in injured versus uninjured cohort (44 [21–75] vs. 25 [17–42]; p = 0.04). Admission base deficit was significantly correlated with syndecan-1 level (r = 0.8, p < 0.001); no association with traumatic brain injury or injury mechanism was seen. Children with elevated syndecan-1 on admission had significantly increased odds of poor outcome; every 10 ng/mL increase in syndecan-1 was associated with 10% increased odds of death or transfusion (p < 0.001). Transfusion with any blood product was associated with a significant decrease in syndecan-1 from arrival to 24 hours (Δ syndecan-1, −17 [−64 to −5] vs. −8 [−19 to +2]; p < 0001). CONCLUSION Elevated admission syndecan-1 level, suggestive of endotheliopathy, was associated with shock and poor outcomes in pediatric trauma. Larger cohort studies are required to fully describe the complexities of trauma-induced coagulopathy and investigate the benefit of therapies targeting endotheliopathy in children. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.

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“…Trauma and burns can result in strong pro-inflammatory host responses mostly driven by enormous amounts of circulating DAMPs with ensuing endothelial hyper-permeability and organ failure. Circulating levels of endothelial glycocalyx constituents in trauma are associated with adverse outcome [ 53 ].…”

Section: Question 5 What Are Explorative Tpe Indications For Critical...mentioning

confidence: 99%

Research priorities for therapeutic plasma exchange in critically ill patients

David¹,

Russell²,

Castro³

et al. 2023

ICMx

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Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to “TPE in the critically ill patient”. These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk–benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.

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Syndecan-1 as a severity biomarker for patients with trauma

Cited by 10 publications

References 30 publications

Clinical Value of Syndecan-1 Levels in Trauma Brain Injury: A Meta-Analysis

Clinical Value of Syndecan-1 Levels in Trauma Brain Injury: A Meta-Analysis

Endotheliopathy of trauma in children: The association of syndecan-1 with injury and poor outcomes

Research priorities for therapeutic plasma exchange in critically ill patients

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