(1432) Syndecan-1 Combined With Sublingual Microcirculation Parameters Predict Prognosis in Septic Patients

Introduction: During resuscitation in sepsis, early microcirculation changes are better predictors of outcome than macrocirculation. The degradation of glycocalyx coated on the luminal surface of vascular endothelial cells is considered to be one of the causes of microcirculation dysfunction in sepsis. Syndecan-1, the shedding component of glycocalyx, can reflect the degradation of glycocalyx. Intravital microscopy can directly observe the sublingual microcirculation by sidestream dark field (SDF) imaging. This study was to combine plasma syndecan-1 with sublingual microcirculation parameters to predict prognosis in septic patients.

Methods: This study was a prospective observational study. ICU Adult patients with septic shock were enrolled. Blood samples were collected on day0, day1 and day2 to detect the plasma syndecan-1 concentration. Sublingual microcirculation images were collected to analyze the relevant microcirculation parameters, including total vessel density (TVD), perfusion vessel density (PVD), De Backer score, microvascular flow index (MFI), perfusion vessel proportion (PPV), heterogeneity index (HI) and perfused boundary region (PBR) analyzed by Glycocheck™ software. Clinical characteristics, length of ICU stay and hospital stay, and 30-day mortality were also collected.

Results: A total of 58 septic shock patients were enrolled. TVD and PVD in survival group (n=24) were significantly higher than those in non-survival group (n=34) (p=0.044, p=0.047; respectively), and there were no significant differences in other parameters such as De Backer score, MFI, PPV, and HI. The plasma syndecan-1 concentration in survival group was lower than that of the non-survival group at the corresponding time point. Compared with non-survival group, the values of Δsyndecan-1(day2-day0) decreased more significantly (-12.8±26 vs -4.2±33.3) in survival group. PBR was also lower in survival group. Survival analysis showed that 30-day mortality in the syndecan-1 decreased group was lower than the increased group (p=0.022).

Conclusions: Microcirculation is a key element of prognosis in sepsis. The trend of plasma syndecan-1 changes and sublingual microcirculation parameters are related to the prognosis in septic patients. A more significant decline and lager Δ values in syndecan-1 may indicate a better prognosis.