by Alexandros Rovas,
Laura Mareen Seidel, Hans Vink, Timo Pohlkötter, Hermann Pavenstädt, Christian
Ertmer, Michael Hessler and Philipp Kümpers
Critical Care: volume 23, Article number: 260 (2019)
Background:
The
endothelial glycocalyx (eGC) covers the luminal surface of the vascular
endothelium and plays an important protective role in systemic inflammatory
states and particularly in sepsis. Its breakdown leads to capillary leak and
organ dysfunction. Moreover, sepsis-induced alterations of sublingual
microcirculation are associated with a worse clinical outcome. The present
study was performed to investigate the associations between eGC dimensions and
established parameters of microcirculation dysfunction in sepsis.
Methods:
This
observational, prospective, cross-sectional study included 40 participants, of
which 30 critically ill septic patients were recruited from intensive care
units of a university hospital and 10 healthy volunteers served as controls.
The established microcirculation parameters were obtained sublingually and
analyzed according to the current recommendations. In addition, the perfused
boundary region (PBR), an inverse parameter of the eGC dimensions, was measured
sublingually, using novel data acquisition and analysis software (GlycoCheck™).
Moreover, we exposed living endothelial cells to 5% serum from a subgroup of
study participants, and the delta eGC breakdown, measured with atomic force
microscopy (AFM), was correlated with the paired PBR values.
Results:
In
septic patients, sublingual microcirculation was impaired, as indicated by a
reduced microvascular flow index (MFI) and a reduced proportion of perfused
vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002;
PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in
septic patients compared to those in healthy controls, indicating damage of the
eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated
exceptionally well with paired PBR values obtained at the bedside
(rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters
correlated well with the markers of critical illness. Interestingly, no
association was observed between the PBR values and established microcirculation
parameters.
Conclusion:
Our
findings suggest that eGC damage can occur independently of microcirculatory
impairment as measured by classical consensus parameters. Further studies in
critically ill patients are needed to unravel the relationship of glycocalyx
damage and microvascular impairment, as well as their prognostic and
therapeutic importance in sepsis.
Trial
registration:
Retrospectively
registered: Clinicaltrials.gov, NCT03960307
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