222 Evaluating Syndecan-1 as a Predictive Marker of Sepsis in Thermally Injured Patients

• Published in: Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S78-S78
• Main Authors: Radomski, S N, Ball, R, Bravo, M, Brummell-Ziedins, K, Orfeo, T, Mclawhorn, M, Moffatt, L, Shupp, J W
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iry006.144

Abstract Introduction Sepsis is a complex process that is not entirely understood but may involve endothelial damage and dysfunction. Syndecan-1 is a component of the endothelial glycocalyx that is released into the bloodstream during disruption. Increased levels of syndecan-1 have been shown to be associated with poor outcomes in septic patients but its role in burn patients is unknown. This study aims to investigate the relationship between the development of sepsis in burn patients and levels of syndecan-1. Methods Blood samples were serially collected from 35 thermally injured patients per IRB-approved protocol. Baseline samples were collected within 4 hours of injury and additional blood samples were collected at designated intervals depending on length of hospital stay up to day 21. Syndecan-1 levels were quantified by ELISA. Vital signs, white blood cell counts, microbiology data, and medication administration history were reviewed. Patients were identified as septic using the SIRS criteria and the presence of either a positive culture or administration of empiric antibiotics. T-tests were performed. Results Of the 35 patients, 11 became septic during their hospital admission. At baseline, mean syndecan-1 levels were significantly higher in the septic (55 ± 48 ng/mL) group than the non-septic (16 ± 12 ng/mL) group (p=0.03). The trajectories of syndecan-1 levels differed between the septic and non-septic groups. In patients with ≥ 8 collection time points over a minimum of 48 hours (n=20) maximum levels of syndecan-1 were found at much earlier time points in the non-septic group (n=9) than in the septic group (n=11). Peak levels of syndecan-1 occurred between hours 4–8 in 89% (n=8) of the non-septic group and after day 4 of admission in 73% (n=8) of the septic group. In 5 of the septic patients, an acute rise in syndecan-1 levels was noted between the time point preceding the development of sepsis and the time point corresponding to the development of sepsis (average fold increase 3.6). Conclusions Syndecan-1 levels may be a predictor of the development of sepsis. The trajectory of the levels during admission differs between patients who develop sepsis and those who do not. Further research on the exact trajectories of syndecan-1 release from the glycocalyx could lead to a novel marker to predict the development of sepsis in this unique population. Applicability of Research to Practice Further research on the exact trajectory of syndecan-1 prior to t