Association between serum endothelial cell-specific molecule 1 and cirrhotic cardiomyopathy / 临床肝胆病杂志

ObjectiveCirrhotic cardiomyopathy （CCM） refers to cardiac dysfunction and electrophysiological disorder caused by liver cirrhosis and is closely associated with the prognosis of patients with liver cirrhosis. Endothelial cell-specific molecule 1 （endocan） can be used as a diagnostic marker for cardiovascular diseases， and it remains unclear whether it is involved in the pathogenesis of CCM. The aim of this study is to investigate the expression of serum endocan in patients with CCM and its possible role in the development of CCM. MethodsThis cross-sectional study was conducted among the patients with liver cirrhosis who were consecutively admitted to Beijing YouAn Hospital， Capital Medical University， from January 2019 to January 2021， and according to the presence or absence of CCM， the patients were divided into CCM group with 19 patients and non-CCM group with 106 patients. ELISA was used to measure the serum level of endocan， and its correlation with liver function and cardiac function was analyzed. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U rank sum test was used for comparison of continuous data with skewed distribution between two groups； the chi-square test was used for comparison of categorical data between groups. A Pearson or Spearman correlation analysis was used to investigate the correlation between indicators， and the receiver operating characteristic （ROC） curve was used to assess the CCM predictive model. ResultsThe CCM group had a significantly higher expression level of serum Endocan than the non-CCM group （2.69±0.43 ng/mL vs 2.23±0.52 ng/mL， t=2.247， P=0.034）. The patients with compensated cirrhosis had a significantly lower expression level of serum endocan than those with decompensated cirrhosis （2.41±0.37 ng/mL vs 2.72±0.49 ng/mL， t=3.214， P=0.02）. In the CCM group， the serum level of endocan was positively correlated with Child-Pugh score （r=0.509， P=0.026） and MELD-Na score （r=0.484， P=0.036） and was negatively correlated with mean arterial pressure （r=-0.591， P=0.013） and mitral ratio of peak early to late diastolic filling velocity （r=-0.515， P=0.042）. The serum endocan had an area under the ROC curve of 0.658 （95%CI： 0.522～0.781） in predicting CCM， when the cut-off value was 2.61 ng/mL， the sensitivity was 67.1% and the specificity was 73.7%. ConclusionThere is a certain association between serum endocan and CCM， and serum endocan may be involved in the pathogenesis of CCM.

Value of serum Endocan in the assessment of disease severity and prognosis for elderly multiple organ dysfunction syndrome patients / 中华老年医学杂志

Objective:To examine the significance of serum Endocan levels in evaluating the severity of disease and predicting the prognosis for elderly patients with multiple organ dysfunction syndrome(MODS).Methods:Seventy-five elderly patients from the Department of Geriatric ICU at the First Affiliated Hospital of Nanjing Medical University were selected and divided into two groups: the non-MODS group and the MODS group.This division was based on the levels of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores and MODS scores within 24 hours of admission.Additionally, 40 elderly individuals undergoing physical examination were included as a control group.Venous blood samples were collected from all participants to detect the levels of Endocan using ELISA.The patients were further categorized into the survival group and the death group based on their clinical outcome within 28 days.The Endocan levels in all groups were compared, and receiver operating characteristic(ROC)curves were generated to assess the value of Endocan in determining the severity of the disease and predicting prognosis in elderly MODS patients.Results:The levels of Endocan were found to be higher in the MODS group compared to the non-MODS and control groups[(622.3±149.2)ng/L vs.(433.1±189.7)ng/L, P<0.001]. Furthermore, patients with higher APACHE Ⅱ and MODS scores exhibited higher levels of Endocan.The area under the ROC curve(AUC)for Endocan, MODS score, and Endocan+ MODS score were 0.791, 0.806, and 0.820, respectively( P>0.05). Similarly, the AUC for Endocan, APACHE Ⅱ score, and Endocan+ APACHE Ⅱ score were 0.763, 0.799, and 0.803, respectively( P>0.05). Interestingly, the survival group had lower levels of Endocan compared to the death group[(444.6±193.6)ng/L vs.(618.2±149.5)ng/L, P<0.001]. Conclusions:Endocan can be utilized as a noteworthy indicator, which is associated with the seriousness of illness and the prognosis for elderly patients with multiple organ dysfunction syndrome(MODS).

Evaluation of subclinical atherosclerosis in obese patients with three noninvasive methods: Arterial stiffness, carotid intima-media thickness, and biomarkers of endothelial dysfunction

ABSTRACT Objective: In this study, we aimed to evaluate subclinical atherosclerosis in patients with obesity who had cardiovascular disease risk indicators such as arterial stiffness, which is evaluated using pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and biomarkers of endothelial dysfunction such as endocan, ADAMTS97, and ADAMTS9. Subjects and methods: Sixty obese subjects, including 23 subjects with body mass index (BMI) ≥ 40, 37 subjects with BMI ≥ 30 but < 40, and 60 age-and sex-matched control subjects, were included in our study. Serum endocan, ADAMTS97, and ADAMTS9 levels as well as PWV and CIMT measurements of the subjects in the obese and control groups were performed. Results: In the obesity group, PWV levels were significantly higher than they were in the control group and endocan levels were significantly lower than they were in the control group. When we compared the obese group with BMI ≥ 40 and the control group, the BMI ≥ 40 group had significantly higher PWV and CIMT levels than the control group had, whereas endocan, ADAMTS7, and ADAMTS9 levels were similar to those of the control group. When we compared the obese group with BMI ≥ 30 < 40 to the control group, endocan levels were lower in the group with BMI ≥ 30 < 40, and PWV and CIMT levels were similar to the control group. Conclusions: We found that arterial stiffness and CIMT increased in obese patients with BMI ≥ 40 and that increased arterial stiffness was associated with age, systolic blood pressure, and HBA1C. In addition, we found that the endocan levels were lower in obese patients than they were in nonobese control individuals.

Research progress on the role of endothelial cell-specific molecular-1 in acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS), a common respiratory critical illness with multiple causes, is associated with high mortality. The high degree of heterogeneity may be the reason why it is lack of highly specific and sensitive biological biomarkers. Therefore, it is an urgent need to explore biomarkers, perform phenotypic analysis and establish risk stratification model for diagnosis, prognosis, and treatment of ARDS. Endothelial cells specificity molecular-1 (ESM-1, endocan), is a soluble dermatan sulfate proteoglycan, and be involved in regulating biological behaviors such as cell proliferation, differentiation and migration. Numerous studies have confirmed that ESM-1 is closely related to inflammation, endothelial activation and dysfunction. However, the role of ESM-1 in the initiating and developing process of ARDS is still unclear. To provide a scientific basis for its clinical applications in ARDS, such as early prognosis assessment and timely prevent strategies, this paper focuses on the biological properties and the clinical value of ESM-1 as a potential biomarker for ARDS.

Evaluation of Endothelial Dysfunction in Bipolar Affective Disorders: Serum Endocan and Urotensin-II Levels

OBJECTIVE: This study investigated changes in urotensin-II (U-II) and endocan levels which can be used as an early biological marker of endothelial injury in the episode and remission phases of bipolar affective disorder (BAD). METHODS: We compared endocan and U-II levels, which has been shown to be closely associated with neurotransmitter systems in addition to continuity of endothelial structure and inflammatory response, in patients with BAD in remission for at least one year (n=42) and in patients still in manic or depressive episodes (n=16) with healthy controls (n=30). RESULTS: Both endocan and U-II levels were significantly higher in the bipolar patients than in the controls. Endocan and U-II levels were also significantly correlated with one another (p=0.000, r=0.833). Both endocan (p=0.000) and U-II levels (p=0.000) were significantly higher in the bipolar attack group compared to the subjects in remission, and in the remission group compared to the controls. CONCLUSION: In this study we determined significantly higher endocan and U-II levels in BAD compared to the controls, while serum endocan and U-II levels of patients undergoing attacks were also significantly higher than those of the controls and also those of patients in remission.

Expressions of endocan, vascular endothelial growth factor and matrix metalloproteinase-9 and their significances in pituitary adenomas apoplexy / 中华神经医学杂志

Objective To detect the expressions of endocan,vascular endothelial growth factor (VEGF),and matrix metalloproteinase-9 (MMP-9) and their significances in pituitary tumor tissues.Methods (1) Eighty pituitary tumor specimens,collected during surgical resection and after pathological examination confirmation in our hospital from January 2005 to December 2014,were used in our experiment;40 of them were from patients with pituitary adenomas apoplexy and 40 of them were without apoplexy;the expressions ofendocan,VEGF and MMP-9 in these pituitary tumor tissues were detect by immunohistochemical methods.(2) Twenty patients with pituitary tumor,performed surgical resection and pathological examination confirmation in our hospital from January 2015 to October 2015,chosen,and their tumor specimens were used in our experiment;10 of them were from patients with pituitary adenomas apoplexy and 10 of them were without apoplexy;the endocan mRNA expression in these pituitary tumor tissues were detect by reverse translation-PCR (RT-PCR).Results (1) Thirty-one,33 and 30 specimens in apoplexy group had positive expressions of endocan,VEGF and VEGF;24,26 and 20 specimens in non-apoplexy group had positive expressions of endocan,VEGF and VEGF;as compared with those in the non-apoplexy group,the immunorective scale (IRS) scores of protein expressions of endocan,VEGF and VEGF in apoplexy group were significantly higher (P＜0.05);endocan and VEGF protein expressions were positively correlated (r=0.555,P=0.000);endocan and MMP-9 protein expressions were positively correlated (r=0.423,P=0.006);VEGF and MMP-9 protein expressions were positively correlated (r=0.621,P=0.000).(2) The endocan mRNA expression in apoplexy group was significantly higher than that in non-apoplexy group ([17.53 ±8.95] × 10-3 vs.[4.67±3.03]×10-3,P＜0.05).Conclusion Endocan,VEGF and MMP-9 proteins may play important roles in the process of pituitary adenoma apoplexy.

Clinical value of serum endocan and procalcitonin in early diagnosis and prognosis evaluation of sepsis / 中华危重病急救医学

Objective To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis.Methods The patients with systemic inflammatory response syndrome (SIRS,n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHE Ⅱ, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis.Results ① Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHE Ⅱ:18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, allP < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHE Ⅱ, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. ② With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHE Ⅱ: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; allP < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHE Ⅱ, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. ③ Serum endocan, PCT, APACHE Ⅱ and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L):18.40 (16.99) vs. 3.10 (6.67), APACHE Ⅱ: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, allP < 0.01]. The AUC of endocan, PCT, APACHE Ⅱ, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%.Conclusions Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.

Endocan and Non-Dipping Circadian Pattern in Newly Diagnosed Essential Hypertension

BACKGROUND AND OBJECTIVES: Non-dipper hypertension is frequently accompanied by endothelial dysfunction and activation. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. This study aims to investigate the association between circadian blood pressure (BP) pattern and plasma endocan levels together with high-sensitivity C-reactive protein (hsCRP) in patients with newly diagnosed untreated hypertension. SUBJECTS AND METHODS: Twenty-four hour ambulatory blood pressure monitoring was recorded in 35 dipper, 35 non-dipper hypertensives and 35 healthy controls. Endocan levels were measured by enzyme-linked immunosorbent assay. Serum levels of hsCRP were also recorded. RESULTS: Despite similar daytime and 24-hour average BP values between dippers and non-dippers, statistically significant high nocturnal BP was accompanied by a non-dipping pattern (Systolic BP: 132±9 vs. 147±11 mmHg; Distolic BP: 80±7 vs. 91±9 mmHg, respectively, p<0.001 for both). Non-dipper patients demonstrated higher endocan levels compared to dippers and normotensives (367 (193-844) pg/mL, 254 (182-512) pg/mL and 237 (141-314) pg/ml, respectively, p<0.001). HsCRP levels were significantly higher in non-dippers than the other groups (p=0.013). In a multivariate logistic regression analysis, endocan (p=0.021) and hsCRP (p=0.044) were independently associated with a non-dipping pattern. CONCLUSION: Elevated endocan levels were found in non-dipper groups. Endocan and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that elevated levels of endocan in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to the possible future role of endocan in selection of hypertensive patients at higher risk or target organ damage.

Plasma endocan level and prognosis of immunoglobulin A nephropathy

BACKGROUND: Endocan, previously called endothelial cell–specific molecule-1, is a soluble proteoglycan that is secreted from vascular endothelial cells. Elevated plasma endocan levels were shown to be associated with poor cardiovascular outcomes in patients with chronic kidney disease (CKD). We investigated the clinical relevance of plasma and urine endocan levels in patients with immunoglobulin A nephropathy (IgAN). METHODS: Sixty-four patients with IgAN and 20 healthy controls were enrolled in this study. Plasma and urine endocan levels were measured. Clinical parameters, pathologic grades, and renal outcomes were compared among subgroups with different plasma and urine endocan levels. RESULTS: Both plasma and urine endocan levels were significantly higher in patients with IgAN than in controls. Elevated serum phosphorus and C-reactive protein were independent determinants for plasma endocan, and elevated C-reactive protein was also an independent determinant for urine endocan levels in multivariate analysis. Plasma endocan level was not significantly different across CKD stages, but patients with higher plasma endocan levels showed adverse renal outcome. Urine endocan levels were also elevated in patients with poor renal function. Cox proportional hazard models showed that high plasma endocan was an independent risk factor for CKD progression after adjusting for the well-known predictors of outcome in patients with IgAN. CONCLUSION: This study suggested that plasma endocan might be useful as a prognostic factor in patients with IgAN.