INTERACTION OF ENDOTHELIAL GLYCOCALYX WITH HEMODYNAMIC AND METABOLIC RESPONSE IN PATIENTS WITH SEPTIC SHOCK AND IN CARDIOSURGICAL INTERVENTIONS USING CARDIOPULMONARY BYPASS

The endothelial glycocalyx (EG) system is an important protective regulator of vascular integrity and permeability, provides cellular interaction and serves as a component of hemostasis. Damage of EG in septic shock, cardiopulmonary bypass (CPB), trauma, ischemia and in a number of other critical states leads to capillary leakage, hemodynamic and metabolic disorders. The aim of the study was to evaluate the interaction of EG components with hemodynamic and metabolic response in patients with septic shock and in cardiosurgical interventions using CPB. Materials and methods. The study included 21 patients with septic shock and 26 patients undergoing cardiac surgery with CPB. The plasma concentrations of EG components, including heparin-sulfate proteoglycan (HSPG) and syndecan 1 (S1), were determined in the group of patients with septic shock at baseline, 2 and 24 hours after the fluid load test, and in the group of cardiosurgical patients – after induction of anesthesia, at 6 and 24 hours after the end of CPB. Results. In septic shock, the concentration of S1 in blood plasma tended to increase at 2 hours after the fluid load test. In cardiosurgical patients, at 6 hours after the end of CPB, the plasma concentration of HSPG reduced from 6.13 (4.20–9.04) to 5.08 (4.18–7.21) ng/ml (p <0.01), whereas S1 increased from 0.80 (0.56–1.13) to 1.25 (1.04–1.41) ng/ml (p <0.001). At 24 hours, HSPG and S1 returned to values close to baseline. In both groups, we established the relationship of the EG components with the parameters of pre- and afterload, as well as with the concentration of lactate. Conclusion. The damage of EG in septic shock and in cardiosurgical interventions using CPB is related with disorders of hemodynamics and metabolism.