Methods: Commercial ELISAs for Glypicans 1,2,3, and 4 was used for analyzing plasma from 10 patients with severe sepsis and 10 healthy controls as an initial screening. Further on plasma Glypican-4 was analysed in a cohort of 202 emergency department patients with a suspected infection. We classified the patients into severe sepsis/septic shock, sepsis and infection without SIRS and analysed the Glypican-4 levels in these patient groups. Correlations between Glypican-4 and other commonly used markers were investigated.
Results: In the pilot study only Glypican-1 (P=0.015) and Glypican-4 (P=0.031) were significantly increased in the severe sepsis/septic shock groups. Glypican-4 levels were also significantly higher (P<0.001) in the severe sepsis/septic shock group (n=64) compared to the sepsis group (n=83). The patients with sepsis (n=83) had significantly higher Glypican-4 levels than patients with infection without SIRS (n=37), (P=0.016). The concentrations of Glypican-4 correlated positively (P<0.001) to Heparin-binding protein, CRP, lactate, Procalcitonin and negatively (P<0.001) to Apolipoprotein M and Sphingosine-1-phosphate.
Conclusion: We show that Glypican-4 is elevated in plasma of patients with severe sepsis/septic shock and correlate with disease severity and other markers of endothelial dysfunction and systemic inflammation.