Author Of 1 Presentation
DEGRADED COMPONENTS OF THE ENDOTHELIAL GLYCOCALYX ARE ASSOCIATED WITH ACIDOSIS IN CHILDREN FOLLOWING SURGERY WITH CARDIOPULMONARY BYPASS
Abstract
Background
Metabolic acidosis is highly prevalent in young children following surgery with cardiopulmonary bypass (CPB). The endothelial glycocalyx is degraded during CPB. We hypothesised that the negatively charged glycocalyx components, heparan sulfate and syndecan-1, may contribute to metabolic acidosis in these patients.
Objectives
To assess the association between glycocalyx components in plasma (syndecan-1 and heparan sulfate) and metabolic acidosis quantified using Stewart's strong ion gap (SIG).
Methods
We prospectively sampled plasma at multiple time points from baseline (pre-surgery), intraoperatively and at PICU admission in 27 children <5 years of age undergoing cardiac surgery with CPB. We measured syndecan-1 and heparan sulfate using ELISAs, and full routine biochemical and haematological data (including components of the SIG).
Results
Glycocalyx components increased from baseline to a maximum at end of CPB across the cohort (paired t-test; syndecan-1 33 ng/ml, 95% CI 15–51, versus 168, 95% CI 146–189, p<0.001; heparan sulfate 11 mcg/ml, 95% CI 9–13, versus 25, 95% CI 22–28, p<0.001). The SIG was calculable on 26 patients on admission to PICU. Multivariable linear regression yielded an association between glycocalyx components and SIG (R2=0.23). Of these, heparan sulfate was the strongest predictor (coefficient 0.20, p=0.06).
Conclusion
We provide pilot data on an association between degradation of the glycocalyx, and increased SIG in children following surgery with CPB. Further analyses, including modelling of individual participants with clinical outcome data are pending.