Abstract: TH-PO112
Endothelial Glycocalyx Shedding and Microcirculatory Impairment in Traumatic Haemorrhagic Shock Are Early Markers of AKI
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Joslin, Jennifer R., King's College London, London, United Kingdom
- Naumann, David N., University of Birmingham, Birmingham, United Kingdom
- Bramham, Kate, King's College London, London, United Kingdom
- Hutchings, Sam, King''s College Hospital, London, United Kingdom
Background
Microcirculatory disruption is evident in the pathogenesis of many acute kidney injury (AKI) causes, and regulation of microvascular perfusion is dependent on the integrity of the endothelial glycocalyx (Glx). We hypothesised that systemic Glx shedding and microcirculatory impairment are associated with AKI. The MICROSHOCK study reported on multiple organ dysfunction syndrome; we report the association with Glx and microcirculatory changes and AKI outcomes for the first time.
Methods
Patients with traumatic haemorrhagic shock from two UK Major Trauma Centres underwent plasma sampling for Syndecan-1 (Syn-1, Glx constituent) and sublingual Incident Dark Field (IDF) microscopy on admission. IDF videos were analysed to quantify perfused vessel index (PVD) and microvascular flow index (MFI). Presence and stage of AKI within 7 days were recorded.
Results
45 patients were included; 10 (22%) female and 35 (78%) male. Mean age was 45 (SD 26) years. 34 of 45 (76%) developed AKI within 7 days; 15 (44%) stage 1; 12 (35%) stage 2; and 7 (21%) stage 3.
Syn-1 results were available for 17 patients. Admission Syn-1 concentration was significantly higher (representing increased Glx shedding) in patients who did (n=11) than did not (n=6) develop AKI within 7 days, p = 0.0183 (Figure 1).
PVD and MFI results were available in all 45 patients. Both PVD and MFI were significantly lower (representing impaired microcirculatory perfusion) in patients who went on to develop stage 2 or 3 AKI (Table 1).
Conclusion
This novel study provides preliminary evidence that Glx shedding and impaired microcirculatory perfusion parameters can predict AKI. Further research in other and larger cohorts is needed and planned. We propose that Syn-1 may be a mechanistic biomarker for AKI.
Table 1: PVD and MFI in patients who did and did not develop AKI
| AKI | No AKI | Severe (stage 2 or 3) AKI | No severe AKI | |||
| Median [IQR] PVD (mm/mm2) | 10.2 [7.9,12.0] | 10.5 [9.6,11.0] | NS | 8.7 [7.6,10.9] | 11.1 [10.3,12.5] | p=0.0102 |
| Median [IQR] MFI | 2.70 [2.57,2.85] | 2.81 2.64,2.88] | NS | 2.62 [2.25,2.71) | 2.82 [2.71,2.90] | p=0.0026 |
Figure 1: Syn-1 concentration in patients who did and did not develop AKI