Effect of inflammatory cytokine and glycocalyx marker profiles on sepsis outcomes

Introduction: The purpose of our study was to compare levels of inflammatory cytokines and glycocalyx markers with sepsis outcomes. Methods: A prospective cohort of adult patients with a diagnosis of sepsis by Sepsis-III criteria was identified between August 2021 and March 2022 at Grady Memorial Hospital in Atlanta, GA. Samples were obtained from patients within 48 hours of admission to the ICU. An array of inflammatory cytokines (IL-6, IL-8, IL-10, IL-18) and glycocalyx markers (MCP-1, syndecan) were measured using flow cytometry and ELISA assays. The presence of end-organ failure in three domains (cardiovascular/vasopressor requirement, respiratory, renal) was noted on Days 1 and 7 for evaluation. Multiple linear/logistic regression was used to determine if cytokine levels could significantly predict ICU length of stay, presence of organ failure, or recovery of organ function (i.e., vasopressor requirement on day 1 but not day 7). Results: Thirty-five patients were enrolled and used for data analysis. Syndecan level significantly predicted ICU length of stay [β= 0.006, p=0.048] and recovery of cardiovascular function [β= -0.03, OR 0.98 (0.94-0.99), p < 0.01]. In addition, IL-8 level significantly predicted recovery of cardiovascular function [β= -0.13, OR 0.88 (0.75-0.97), p < 0.01]. MCP-1 level significantly predicted recovery of cardiovascular function [β= -0.005, OR 0.99 (0.98-0.99), p < 0.01] and MV requirement at day 7 [β= -0.005, OR 0.99 (0.98-0.99), p < 0.01]. IL-6, IL-10, and IL-18 did not significantly predict any of the outcomes of interest. No cytokine level significantly predicted day 1 organ failure or recovery of renal failure. Conclusions: The presented results show that of the cytokines studied, syndecan levels had the most predictive power showing a linear relationship to ICU length of stay and a negative association with recovery of cardiovascular function. In addition, MCP-1 levels predicted respiratory failure on day 7 and were negatively associated with recovery of cardiovascular function. Of the inflammatory cytokines, only IL-8 showed a negative association with recovery of cardiovascular function. Overall, there was no association between inflammatory cytokines and glycocalyx markers suggesting distinct physiologic pathways.