Endothelial glycocalyx damage markers as early predictors of pneumonia after thoracic aortic surgery

Objective. To analyze endothelial glycocalyx damage markers in reconstructive thoracic aortic surgery under cardiopulmonary bypass and circulatory arrest (CA), and to identify correlations with postoperative pneumonia. Material and methods. This study included 39 patients with thoracic aortic disease requiring reconstructive surgery under CA and unilateral antegrade cerebral perfusion. Serum biochemical markers of endothelial glycocalyx damage — syndecan-1 (SDC-1), heparan sulfate proteoglycan (HSPG), and hyaluronic acid (HA) — were analyzed intraoperatively and in early postoperative period. Postoperative course and incidence of pneumonia were assessed. Results. The ROC analysis revealed risk factors of pneumonia depending on serum HA after 4 and 24 postoperative hours. Higher risk of pneumonia followed HA >51.67 ng/mL after 4 hours (sensitivity 72.7%, specificity 85.7%) and >48.29 ng/mL after 24 hours (sensitivity 72.7%, specificity 71.4%). Conclusion. Identifying early predictors of pneumonia in thoracic aortic surgery is clinically relevant. Elevated HA can be considered an early predictor of postoperative pneumonia, potentially enabling initiation of timely targeted prophylaxis to mitigate this complication.