Biomarkers of endothelial cell dysfunction persist beyond resuscitation in patients with hemorrhagic shock. Issue 5 (5th November 2022)

• Record Type: Journal Article
• Authors: Zeineddin, Ahmad; Wu, Feng; Chao, Wei; Zou, Lin; Vesselinov, Roumen; Chipman, Amanda M.; Dong, Jing Fei; Huang, Huang; Pati, Shibani; Kozar, Rosemary A.
• Is Part Of: Journal of trauma and acute care surgery. Volume 93:Issue 5(2022)
• Page Start: 572
• Page End: 578
• Publication Date: 2022-11-05
• Subjects: Hemorrhagic shock -- endotheliopathy -- coagulopathy -- micoroRNA-19b -- syndecan-1; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003758
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : In a prospective observational study of severe trauma/hemorrhagic shock patients, markers of endothelial dysfunction/activation remained high through 24-hours post resuscitation and achieving hemostasis. Admission Syndecan-1 level was the strongest predictor of clinical outcomes. Abstract : BACKGROUND: It has been shown that microRNA-19b (miR-19b) binds to and degrades syndecan-1 after hemorrhagic shock (HS) and contributes to endothelial dysfunction in vitro and in vivo. The objective of the current study was to assess longitudinal changes in miR-19b and syndecan-1 in HS patients. METHODS: Blood samples from HS patients (blood pressure <90 mm Hg and ≥2 U blood) were collected upon admission, completion of hemostasis, and after 24 hours for miR-19b (quantitative reverse transcription PCR) and syndecan-1 (enzyme-linked immunosorbent assay) and compared with controls and minimally injured (Injury Severity Score, ≤9). Inflammatory cytokines were measured (Luminex [Thermo Fisher, Waltham, MA]). Correlations between syndecan-1, miR-19b, inflammatory markers, and patient outcomes were performed. Logistic regression models were developed for outcomes. RESULTS: Thirty-four HS patients were studied: age, 46 (19–89) years; male, 82%; penetrating, 35%; Injury Severity Score, 24 ± 10; and blood products at 24 hours, 21 ± 19 U. MicroRNA-19b was increased upon arrival and further increased over time: 4.6 → 6.7 → 24.1-fold change compared with 0.1 and 1.2 for minimally injured patients and controls, respectively. Syndecan-1 was increased to 42.6 → 50 → 51.5 ng/mL over time compared with 14.7 and 23.5 for minimally injured and controls, respectively. Values for both biomarkers remained significantly increased through 24 hours and were associated with a persistent increase in inflammatory cytokines. Admission syndecan-1 significantly predicted mortality, coagulopathy, and massive transfusion. CONCLUSION: We have shown for the first time that miR-19b and syndecan-1 were biomarkers for endothelial dysfunction independent of resuscitation. MicroRNA-19b did not demonstrate a strong correlation with syndecan-1 nor outcomes. Admission syndecan-1, however, remains a strong prognostic marker, but its elevation over time suggests a versatile role following HS that requires further investigation. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level II. Abstract :