关键词: 多配体蛋白聚糖-1, 血管内皮-钙粘蛋白, 神经元特异性烯醇化酶, 脓毒性休克, 老年患者, 脓毒症相关性脑病

Abstract:

Objective To evaluate the prognostic value of syndecan-1， VE-cadherin， and neuron-specific enolase（NSE） in elderly patients with sepsis-associated encephalopathy（SAE）. Methods Elderly patients with septic shock admitted to the ICU of the First Hospital of Changsha between January 2022 and August 2024 were enrolled in this study. Serum levels of syndecan-1， VE-cadherin， and NSE were measured on the first and third days following ICU admission in these elderly patients with septic shock. The optimal cut-off values， sensitivity， and specificity of syndecan-1， VE-cadherin， and NSE for predicting SAE were further analyzed. Results Ninety-six elderly patients with septic shock were enrolled in this study， comprising 40 cases in the SAE group and 56 cases in the non-SAE group. Sequential organ failure assessment scores， acute physiology and chronic health evaluation scores， and 28-day mortality rates were significantly higher in the SAE group compared to the non-SAE group （P < 0.05）. The serum levels of syndecan-1， VE-cadherin， and NSE on both the first and third days were significantly elevated in the SAE group compared to the non-SAE group （P < 0.05）. Elevated serum levels of syndecan-1， VE-cadherin， and NSE on the third day were identified as independent risk factors for SAE. On the third day， serum syndecan-1 levels （AUC = 0.798， 95%CI： 0.709 ~ 0.886， optimal cutoff = 160.80 ng/mL， sensitivity = 71.43%， specificity = 72.50%）， serum VE-cadherin levels （AUC = 0.847， 95%CI： 0.768 ~ 0.927， optimal cutoff = 2，429.00 ng/mL， sensitivity = 78.57%， specificity = 82.50%）， and serum NSE levels （AUC = 0.765， 95%CI： 0.670 ~ 0.861， optimal cutoff = 14.24 ng/mL， sensitivity = 53.57%， specificity = 92.50%） were all effective predictors of SAE. Notably， the combination of syndecan-1， VE-cadherin， and NSE （AUC = 0.877， 95%CI： 0.806 ~ 0.949， sensitivity = 85.71%， specificity = 80.00%） demonstrated superior performance in predicting SAE. Conclusions Secondary SAE in elderly patients with septic shock is closely associated with blood-brain barrier dysfunction and brain injury. The serum levels of syndecan-1， VE-cadherin， and NSE on the third day demonstrated significant predictive value for SAE. Moreover， the combined assessment of syndecan-1， VE-cadherin， and NSE exhibited superior performance in predicting SAE.

Key words: syndecan-1, VE-cadherin, neuron-specific enolase, septic shock, elderly patients, sepsis-associated encephalopathy