Association between serum endothelial glycocalyx biomarkers and prognosis in paediatric sepsis

OBJECTIVE: To investigate endothelial glycocalyx (eGCX) serum degradation products in children with sepsis and evaluate their association with clinical outcomes. METHODS: This retrospective observational study enrolled children diagnosed with sepsis and age- and sex-matched healthy controls. Sepsis severity was classified as mild or severe according to organ dysfunction and hypoperfusion. Severe cases were further grouped by shock presence, and shock cases were stratified based on 28-day survival. Clinical data were collected at admission, and blood samples were analysed for inflammatory markers (C-reactive protein, interleukin-6, procalcitonin [PCT]) and eGCX biomarkers (syndecan-1 [SDC-1], heparan sulfate [HS], hyaluronic acid [HA]). RESULTS: A total of 85 children with sepsis and 19 healthy controls were included. Serum SDC-1, HS and HA levels were significantly higher in patients with sepsis than in controls. Patients with severe sepsis showed elevated SDC-1, HS and HA levels compared with mild cases, and HA was further increased in those with shock. In the septic shock cohort, non-survivors had higher SDC-1, HS and HA levels than survivors. Moreover, SDC-1, HS and HA positively correlated with inflammatory markers and disease severity. Receiver operating characteristic analyses demonstrated that HA, SDC-1 and HS effectively distinguished severe from mild sepsis. Multivariate analysis identified SDC-1, HA and PCT as independent predictors of severe sepsis. In septic shock, SDC-1 ≥ 89.47 ng/mL predicted significantly lower 28-day survival (P = 0.004). CONCLUSION: Serum eGCX levels are elevated in paediatric sepsis and correlate with inflammation and disease severity, indicating that eGCX biomarkers reflect the extent of endothelial injury and disease progression in paediatric sepsis.