Trajectory of plasma syndecan-1 and heparan sulfate during major surgery: A retrospective observational study.

Abstract

Surgical trauma-induced inflammation during major surgery may disrupt endothelial integrity and affect plasma concentrations of glycocalyx constituents, such as syndecan-1 and heparan sulfate. To date, no studies have focused on their perioperative temporal changes. As part of a trial, we obtained plasma and urine specimens sampled during the perioperative period in 72 patients undergoing major abdominal surgery. The plasma concentration of syndecan-1 and heparan sulfate was measured on five occasions, from baseline to the second postoperative day. Plasma and urinary creatinine and urinary syndecan-1 concentrations were measured before surgery and on the first postoperative morning. We observed three different temporal patterns of plasma syndecan-1 concentration. Group 1 "low" (64% of patients) showed only minor changes from baseline despite a median heparan sulfate increase of 67% (P < 0.005). Group 2 "increase" (21% of patients) showed a marked increase in median plasma syndecan-1 from 27 μg/L to 118 μg/L during the first postoperative day (P < 0.001) with a substantial (+670%; P < 0.005) increase in median plasma heparan sulfate from 279 to 2,196 μg/L. Group 3 "high" (14% of patients) showed a constant elevation of plasma syndecan-1 to > 100 μg/L, but low heparan sulfate levels. The plasma C-reactive protein concentration did not differ across the three groups and 90% of colon surgeries occurred in Group 1. Treatment with dexamethasone was similar across the three groups. Surgical blood loss, duration of surgery, and liver resection were greatest in Group 2. Changes in syndecan-1 and heparan sulfate after surgery appear to show three different patterns, with greatest increases in those patients with greater blood loss, more liver surgery, and longer operations. These observations suggest that increases in syndecan-1 and heparan sulfate reflect the degree of surgical injury.