Endothelial glycocalyx degradation in critically ill foals.
Authors: Gomez Diego E, Kamr Ahmed, Gilsenan William F, Burns Teresa A, Mudge M C, Hostnik Laura D, Toribio Ramiro E
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Endothelial Glycocalyx Degradation in Critically Ill Foals The endothelial glycocalyx—a protective layer lining blood vessel walls—breaks down in septic humans and releases measurable byproducts that signal vascular injury; whether these same biomarkers predict severity and survival in neonatal foals remained unknown until this prospective, multicentre study examined 90 foals aged three days or younger, comparing serum concentrations of syndecan-1, heparan sulfate, angiopoietin-2, and aldosterone alongside plasma atrial natriuretic peptide in 74 hospitalised foals (55 septic, 19 sick non-septic) against 16 healthy controls. Hospitalised and septic foals showed significantly elevated concentrations of all five biomarkers compared to healthy counterparts, with angiopoietin-2 and atrial natriuretic peptide specifically distinguishing non-survivors from survivors. On admission, heparan sulfate levels exceeding 58.7 ng/mL carried a 6.1-fold increased odds of nonsurvival, whilst plasma atrial natriuretic peptide greater than 11.5 pg/mL and serum angiopoietin-2 above 1018 pg/mL in septic foals carried 7.2- and 6.5-fold odds respectively. These findings suggest that glycocalyx degradation biomarkers may serve as practical prognostic indicators during the critical early hours of hospitalisation, potentially enabling clinicians to identify at-risk neonates and stratify treatment intensity accordingly, though further research into whether interventions targeting glycocalyx preservation improve outcomes is warranted.
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Practical Takeaways
- •Endothelial glycocalyx biomarkers (particularly heparan sulfate, ANP, and angiopoietin-2) can serve as prognostic indicators of mortality risk in critically ill and septic neonatal foals.
- •Admission measurement of serum HS, ANG-2, and plasma ANP may help clinicians identify foals at highest risk of death and guide early intervention strategies.
- •These biomarkers reflect endothelial injury severity and may support clinical decision-making regarding treatment intensity and prognosis counseling in neonatal foal intensive care.
Key Findings
- •Serum SDC-1, HS, ANG-2, ALD and plasma ANP were significantly elevated in hospitalized and septic foals compared to healthy foals (P < 0.05).
- •Serum HS > 58.7 ng/mL on admission was associated with 6.1-fold higher odds of nonsurvival in hospitalized foals (95% CI = 1.02-36.7).
- •Plasma ANP > 11.5 pg/mL was associated with 7.2-fold higher odds of nonsurvival in hospitalized foals (95% CI = 1.4-37.4).
- •Septic foals with serum ANG-2 > 1018 pg/mL on admission had 6.5-fold higher odds of nonsurvival (95% CI = 1.2-36.6).