Circulating glycosaminoglycan species in septic shock

Acta Anaesthesiol Scand. 2014 Jan;58(1):36-43. doi: 10.1111/aas.12223. Epub 2013 Nov 7.


Background: Glycosaminoglycans (GAGs) are negatively charged polysaccharides present, e.g., on the luminal face of the blood vessels as heparan sulphate (HS) and hyaluronic acid (HA), in the interstitium as HA, and in neutrofils and plasma as chondroitin sulphate (CS) and HA. Total plasma levels of GAG are increased in human septic shock, but the origin and pathophysiological implications are unclear. In order to determine the source of circulating GAG in sepsis, we compared plasma levels of HS, HA, CS and keratan sulphate (KS) in patients with septic shock and controls.

Methods: HS and KS were measured with enzyme-linked immunosorbent assay, and HA and CS disaccharides with liquid chromatography tandem mass spectrometry in plasma obtained from patients admitted to intensive care fulfilling criteria for septic shock as well as from matched control patients scheduled for neurosurgery.

Results: Median levels of HS and HA were fourfold increased in septic shock and were higher in patients that did not survive 90 days (threefold and fivefold for HS and HA, respectively). Median CS levels were unaltered, while KS levels were slightly decreased in sepsis patients. HS and HA levels correlated with levels of interleukin-6 and interleukin-10. Except for HA, GAG levels did not correlate to liver or kidney sequential organ function score.

Conclusion: Median plasma level of HS and HA is increased in septic shock patients, are higher in patients that do not survive, and correlates with inflammatory activation and failing circulation. The increased levels could be due to vascular damage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • C-Reactive Protein / analysis
  • Chondroitin Sulfates / metabolism
  • Disaccharides / blood
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Glycosaminoglycans / blood*
  • Heparitin Sulfate / blood
  • Humans
  • Hyaluronic Acid / blood
  • Indicators and Reagents
  • Interleukin-10 / blood
  • Interleukin-6 / blood
  • Keratan Sulfate / blood
  • Male
  • Middle Aged
  • Multiple Organ Failure / blood
  • Multiple Organ Failure / diagnosis
  • Peroxidase / blood
  • Sepsis / blood
  • Sepsis / microbiology
  • Shock, Septic / blood*
  • Survival


  • Disaccharides
  • Glycosaminoglycans
  • Indicators and Reagents
  • Interleukin-6
  • Interleukin-10
  • Hyaluronic Acid
  • Chondroitin Sulfates
  • C-Reactive Protein
  • Heparitin Sulfate
  • Keratan Sulfate
  • Peroxidase