Role of Endothelial Glycocalyx Degradation Markers in the Pathogenesis of Sepsis-Induced Myocardial Dysfunction: A Translational Investigation

Abstract

Background: Sepsis-induced myocardial dysfunction (SIMD) is a critical complication in sepsis that contributes to high mortality rates. Understanding its pathogenesis, particularly the role of endothelial glycocalyx degradation, is crucial for developing targeted therapies. Objective: To investigate the association between endothelial glycocalyx degradation markers and the pathogenesis of SIMD, evaluating their potential as biomarkers for diagnosis and prognosis. Methods: A total of 178 sepsis patients (aged 18–85) were enrolled at New York University Grossman School of Medicine between June 2020 and December 2022. Blood samples were collected at baseline and after 24, 48, and 72 hours. Glycocalyx degradation markers (syndecan-1, heparan sulfate, hyaluronic acid) were measured using ELISA. Myocardial dysfunction was assessed by echocardiography and serum troponin levels. Statistical analysis was performed using SPSS version 26.0, with paired t-tests and Pearson’s correlation. Results: Elevated glycocalyx degradation markers correlated significantly with the severity of SIMD. Syndecan-1 levels increased from 300 ± 120 ng/mL at baseline to 650 ± 150 ng/mL (p = 0.03) at 72 hours. Heparan sulfate levels rose from 85 ± 15 ng/mL to 215 ± 50 ng/mL (p = 0.01). Hyaluronic acid increased from 0.5 ± 0.2 µg/mL to 1.5 ± 0.5 µg/mL (p = 0.005). The Pearson correlation between syndecan-1 and troponin levels was 0.85 (p < 0.01). The sensitivity and specificity of syndecan-1 for predicting myocardial dysfunction were 87% and 92%, respectively. Conclusion: Endothelial glycocalyx degradation markers are significantly associated with SIMD and can serve as reliable biomarkers for early diagnosis and prognosis in sepsis.