Endothelial glycocalyx shedding during active COVID-19 infection and its effect on disease severity

ABSTRACT Background COVID-19 pandemic was caused by the SARS-CoV-2 virus that was thought to be associated with microvascular endothelial injury. This study aimed to demonstrate the effect of COVID-19 on markers of endothelial shedding and its effect on patient morbidity and mortality. Settings and design This was a prospective cohort study. Methods This study was conducted at the isolation hospital at Alexandria Main University hospitals on 40 adult patients infected with COVID-19. Patients were divided according to the severity of the presenting symptoms into two groups; moderate and severe. Serum levels of Syndecan-1 and Heparan sulfate were measured at hospital admission and at the end of the first week. Clinical and demographic data along with laboratory investigations and outcomes were compared between the two groups. Results Our results indicated that patients with severe symptoms of COVID-19 had notably high levels of syndecan-1 and Heparan sulfate compared to patients with moderate symptoms on day 1 and day 7. Further investigations revealed that D-dimer, CRP, and IL-6 levels in patients with severe symptoms were higher in patients with severe symptoms. Our results also indicated that IL-6 increased on day 4 and gradually decreased on day 7 in both groups. Furthermore, serum levels of Syndecan-1, Heparan sulfate, D-dimer, and CRP decreased gradually from day 1 to day 7 in both groups. There was an association between markers of endothelial shedding with thrombotic and cardiovascular complications. It seems that the serum Syndecan-1 and Heparan sulfate might be good candidates to monitor COVID-19 activity. Conclusion Patients with severe symptoms of COVID-19 have high serum levels of syndecan 1 compared to patients with moderate symptoms and have higher mortality and more prolonged hospital stay due to more endothelial injury and inflammatory reaction. Syndecan-1 may be used to monitor disease progression and severity.