Biomarkers of endothelial cell dysfunction persist beyond resuscitation in patients with hemorrhagic shock.

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.

• Authors: Ahmad Zeineddin, Feng Wu, Wei Chao, Lin Zou, Roumen Vesselinov, Amanda M Chipman, Jing Fei Dong, Huang Huang, Shibani Pati, Rosemary A Kozar
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 93 Issue 5 Pg. 572-578 (11 01 2022) ISSN: 2163-0763 [Electronic] United States
• PMID: 35939376 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Syndecan-1
• Biomarkers
• MicroRNAs
• Cytokines

Topics

• Humans
• Male
• Middle Aged
• Shock, Hemorrhagic
• Syndecan-1 (metabolism)
• Resuscitation
• Endothelial Cells (metabolism)
• Biomarkers
• MicroRNAs
• Cytokines