Lower serum endocan levels are associated with the development of acute lung injury after major trauma

Abstract

Purpose: Endocan is a proteoglycan expressed by endothelial cells in the lung that may inhibit leukocyte recruitment and thus prevent the development of acute lung injury (ALI). We tested the association of serum endocan levels with subsequent development of ALI after major trauma.

Materials and methods: This was a single-center nested case-control study within a prospective cohort study of major trauma patients. Using an enzyme-linked immunosorbent assay test, we measured endocan levels from admission serum in 24 controls (no ALI) and 24 cases (ALI within 5 days of trauma). Multivariable logistic regression was used to test the association of admission serum endocan levels with subsequent ALI.

Results: Patients who developed ALI had lower levels of endocan on admission (mean, 3.5 ± 1.4 ng/mL vs 4.9 ± 2.6 ng/mL in controls; P = .02). For each 1-unit increase in serum endocan level, the odds ratio for ALI development decreased (0.69; 95% confidence interval, 0.49-0.97; P = .03). Lower endocan levels remained associated with a higher incidence of ALI after adjustment for age and illness severity.

Conclusions: Lower levels of serum endocan on admission are associated with subsequent development of ALI in trauma patients. These observations may be explained by endocan-mediated blockade of leukocyte recruitment in the lung.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Figure 1

Box-plot of serum endocan levels, by whether ALI developed, in 48 major trauma patients. Box plot shows the median (horizontal line) and interquartile range (25th to 75th percentile) (box). The whiskers show the lowest data within 1.5 IQR of the lower quartile and highest data within 1.5 IQR of the upper quartile; data outside 1.5 IQR of the upper quartile are depicted with a dot.

Figure 2

Fitted relationship between serum endocan levels and development of ALI, using a linear regression model. None of the 7 patients with a serum endocan level ≥ 7 ng/mL developed ALI.

Figure 3

Box-plot of serum endocan levels, by whether ALI developed, in 23 blunt-injured trauma patients. Box plot shows the median (horizontal line) and interquartile range (25th to 75th percentile) (box). The whiskers show the lowest data within 1.5 IQR of the lower quartile and highest data within 1.5 IQR of the upper quartile; data outside 1.5 IQR of the upper quartile are depicted with a dot.