Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?
Critical Care volume 23, Article number: 184 (2019)
We read the narrative review by De Freitas Caires et al. with great interest . Acute kidney injury (AKI) is prevalent among patients with sepsis, and a substantial proportion of patients with sepsis-associated AKI (SA-AKI) require renal replacement therapy (RRT) . Continuous RRT (CRRT) is increasingly used (~ 20% SA-AKI) among hemodynamically unstable septic shock patients . Endocan as a novel endothelium-derived soluble dermatan sulfate proteoglycan has a molecular mass of around 20 kDa . The contemporary CRRT membranes are able to remove molecules as large as 35 kDa. Hence, endocan could be removed by CRRT . When new highly adsorptive membranes (HAM) with high absorptive abilities are used, the ability of CRRT to eliminate endocan could be even enhanced . Therefore, the reliability of endocan during CRRT could be altered. De Freitas Caires et al. show that endocan appeared as a consistent good diagnostic criterion as well as procalcitonin (PCT) and could potentially be used for de-escalation therapy in the future (requiring new studies obviously) as PCT. Accordingly (if endocan is used for de-escalation in the future), falsely low endocan in CRRT patients, in turn, could lead to an earlier de-escalation of antibiotics and level of care for septic patients. There has been no investigation on the performance of endocan on patients who receive CRRT. Therefore, we believe there is a critical need for a future study with a focus on the performance of the currently known sepsis biomarkers among those who receive CRRT .
Acute kidney injury
Continuous renal replacement therapy
Highly adsorptive membranes
Renal replacement therapy
De Freitas Caires N, Gaudet A, Portier L, Tsicopoulos A, Mathieu D, Lassalle P. Endocan, sepsis, pneumonia, and acute respiratory distress syndrome. Crit Care. 2018;22(1):280. https://doi.org/10.1186/s13054-018-2222-7.Review.
Peters E, Antonelli M, Wittebole X, Nanchal R, François B, Sakr Y, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care. 2018;22(1):188. https://doi.org/10.1186/s13054-018-2112-z.
Lassalle P, Molet S, Janin A, Heyden JV, Tavernier J, Fiers W, et al. ESM-1 is a novel human endothelial cell-specific molecule expressed in lung and regulated by cytokines. J Biol Chem. 1996;271:20458–64.
Honoré PM, De Bels D, Spapen HD. An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock. Curr Opin Crit Care. 2018;24(6):463–8. https://doi.org/10.1097/MCC.0000000000000542.
Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Evaluating sepsis during continuous dialysis: are biomarkers still valid? Blood Purif. 2014;38(2):104–5. https://doi.org/10.1159/000363497 Epub 2014 Oct 17.
Availability of data and materials
Ethics approval and consent to participate
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This comment refers to the article available at https://doi.org/10.1186/s13054-018-2222-7.
About this article
Cite this article
Honore, P.M., De Bels, D., Attou, R. et al. Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?. Crit Care 23, 184 (2019). https://doi.org/10.1186/s13054-019-2469-7