Impact of acute renal failure on plasmatic levels of cleaved endocan
Critical Care volume 23, Article number: 55 (2019)
Recent failures to improve the prognostic of sepsis have underlined the need for a better phenotypical description of septic subjects. In this view, endocan, an endothelial proteoglycan secreted under proinflammatory conditions, has been described as a useful biomarker to early identify patients at higher risk of poor outcomes during the time course of sepsis . More recently, a major catabolite of endocan, p14, has been observed at high plasmatic levels in a series of septic subjects, paving the way for a more accurate prediction of poor outcomes in such patients. However, major variations of p14 were observed between patients in this series, with unknown clinical significance . Furthermore, it is currently unknown whether p14 could undergo renal elimination.
We performed a post hoc analysis based on the data from a previously published prospective cohort of severe septic patients . Ninety-nine patients underwent measurement of p14 on EDTA plasma. Plasmatic endocan cleavage ratio (ECR) was calculated as plasma p14/(endocan + p14) ratio (endocan and p14 being expressed in pmol/mL) on baseline and 24 h, 48 h, and 72 h following ICU admission. Baseline characteristics of patients are exposed in Additional file 1.
In this cohort, ECR on enrolment was correlated with baseline SAPS 2 (ρ = 0.36, 95% CI (0.17–0.53); p < 10− 3) and SOFA (ρ = 0.21 (0–0.39); p = 0.04). Renal SOFA was the only component of SOFA score associated with higher ECR, with median [IQR] baseline ECR observed at 0.38 [0.29–0.61] in patients with baseline renal SOFA > 2 vs 0.28 [0.19–0.36] in patients with baseline renal SOFA ≤ 2 (p < 10− 3) (Table 1). Over 72 h, patients with a baseline renal SOFA at 4 had higher median plasmatic ECR than those with baseline renal SOFA < 4 (p < 10− 3) (Fig. 1).
Our results suggest that circulating concentrations of p14 might be influenced by the severity of acute renal failure. Therefore, it could be proposed that, by contrast with endocan, p14 could be eliminated through glomerular filtration, thus suggesting that it should be measured in urine rather that in blood. This discrepancy might be explained by the smaller molecular weight of p14, as well as the absence of polyanionic glycanic chain on its protein core. Further explorations are needed to confirm these hypotheses.
Endocan cleavage ratio
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De Freitas Caires N, Legendre B, Parmentier E, Scherpereel A, Tsicopoulos A, Mathieu D, et al. Identification of a 14 kDa endocan fragment generated by cathepsin G, a novel circulating biomarker in patients with sepsis. J Pharm Biomed Anal. 2013;78–79:45–51.
Gaudet A, Parmentier E, Dubucquoi S, Poissy J, Duburcq T, Lassalle P, et al. Low endocan levels are predictive of acute respiratory distress syndrome in severe sepsis and septic shock. J Crit Care. 2018;47:121–6.
This work was supported by BPI France (grant number BPI 2012-05-336). This funding was attributed to D. M, representing Lille University Hospital. There was no role of the funding body in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate
This study has been approved by the ethics committee of Lille University Hospital (approval number CP03/07). All the participants to this study gave their informed consent prior to enrollment.
Consent for publication
The Endomark H1 and DIYEK C1 ELISA kits used in this study were provided by Lunginnov. PL is the cofounder of Lunginnov. ND and LP are staff members of Lunginnov. The remaining authors declare that they have no competing interests.
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Cohort baseline characteristics. Continuous and categorical variables are described as median [interquartile range] and number (percentage), respectively. COPD chronic obstructive pulmonary disease, SOFA Sequential Organ Failure Assessment, ICU Intensive Care Unit SAPS 2 Simplified Acute Physiology Score 2, LIPS Lung Injury Prediction Score (DOC 45 kb)
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Gaudet, A., Parmentier, E., De Freitas Caires, N. et al. Impact of acute renal failure on plasmatic levels of cleaved endocan. Crit Care 23, 55 (2019). https://doi.org/10.1186/s13054-019-2349-1