Endothelial glycocalyx shedding in the acute respiratory distress syndrome after flu syndrome
- PDF / 1,112,239 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 33 Downloads / 214 Views
RESEARCH
Open Access
Endothelial glycocalyx shedding in the acute respiratory distress syndrome after flu syndrome Maira Nilson Benatti1, Alexandre Todorovic Fabro2 and Carlos Henrique Miranda1*
Abstract Background: Scientific evidence indicates that endothelial glycocalyx (EG) shedding contributes to the pathophysiological installation of acute respiratory distress syndrome (ARDS) after bacterial sepsis. The aim was to evaluate the EG shedding in ARDS installation after flu syndrome. Methods: This cross-sectional study included patients with flu syndrome during the influenza outbreak divided into two groups: patients with and without ARDS. Healthy subjects without flu syndrome were included in a control group. We measured EG damage biomarkers (hyaluronan, syndecan-1) and endothelial cell injury biomarker (soluble thrombomodulin) during the first medical evaluation. Histological assessment of the perimeter of the hyaline membrane and the number of neutrophils infiltrated in the alveolar septum was performed in patients who died. Results: ARDS group had 30 patients (44 ± 16 years old, 57% men), the non-ARDS group had 36 patients (39 ± 17 years old, 42% men), and the control group had 35 individuals (44 ± 9 years old, 51% men). Hyaluronan levels were significantly higher in the ARDS group than the two groups [31 ng/ml (interquartile range-IQR 12–56) vs. 5 ng/ml (IQR 3–10) vs. 5 ng/ml (IQR 2–8); p < 0.0001]. Hyaluronan levels above 19 ng/ml in patients with flu syndrome were associated with a significant increase in 28-day mortality rate: relative risk (RR): 6.95; (95% confidence interval 1.88– 25.67); p = 0.0017. A positive correlation was observed between hyaline membrane perimeter and soluble thrombomodulin levels (r = 0.89; p = 0.05) as well as between the number of neutrophils in the alveolar septum and hyaluronan levels (r = 0.89; p = 0.05). Conclusions: Evidence of EG shedding was found in ARDS established after flu syndrome. Keywords: Acute respiratory distress syndrome, Endothelial glycocalyx, Hyaluronic, Influenza virus
Background Respiratory viruses are endemic worldwide and usually cause benign and self-limiting disease. Sometimes, they can reach the lower airway, especially the influenza virus, and trigger severe pneumonia associated with acute respiratory distress syndrome (ARDS) [1, 2]. At times, another respiratory virus can emerge and cause epidemics, * Correspondence: [email protected] 1 Division of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Rua Bernardino de Campos, 1000, Ribeirão Preto, São Paulo 14020-670, Brazil Full list of author information is available at the end of the article
such as recently observed with the SARS-CoV-2 virus [3]. The pathophysiological mechanism behind the establishment of this severe presentation is not precise. Endothelial glycocalyx (EG) is a carbohydrate-rich gelatinous layer that covers the vessels internally [4, 5]. Damage to this structure leads to increased vascular permeability, adhesion,
Data Loading...
