Shedding of endothelial glycocalyx and increased vascular permeability in patients with obstructive jaundice: A prospective observational study

During the perioperative period, increased vascular permeability is associated with elevated morbidity and mortality. Obstructive jaundice (OJ) has been demonstrated to increase vascular permeability. The endothelial glycocalyx (EG), comprising hyaluronic acid (HA), chondroitin sulfate (CS), and syndecan-1 (SDC1), is essential for vascular integrity. However, its role in OJ-related vascular dysfunction remains unclear. This study aimed to investigate whether EG degradation contributes to vascular hyperpermeability in OJ patients. Plasma was preoperatively collected from 35 OJ patients and 33 non-jaundiced controls. EG components (HA, CS, SDC1) and vascular permeability-related mediators, including vascular endothelial growth factor (VEGF), thrombin, sphingosine-1-phosphate, atrial natriuretic peptide, cyclic adenosine monophosphate, and nitric oxide (NO) were quantified. Transendothelial electrical resistance was used to assess endothelial permeability. OJ patients showed significantly increased vascular permeability, which correlated with elevated levels of HA, CS, and SDC1. Concurrently, plasma levels of VEGF, thrombin, atrial natriuretic peptide, and NO were elevated, while the endothelial-stabilizing mediator cyclic adenosine monophosphate was reduced, indicating synergistic EG breakdown and dysregulation of permeability pathways. This study confirms that EG degradation is associated with OJ-induced vascular hyperpermeability. Targeting EG integrity may offer a therapeutic strategy to improve perioperative outcomes, though further studies are needed to establish causality.