Glycocalyx disorders in critical conditions: pathophysiological and clinical aspects
Authors:   anesthesiologist-resuscitator of the intensive care and intensive care wards of G.K. Filippsky City Children's Clinical Hospital, Stavropol, Vorobyova A.P. , Bykov Yu.V. ,   PhD, assistant of professor of the Department of Department of Anesthesiology and Intensive care with a course of additional professorial education of Stavropol State Medical University, Federal State Educational Institution of the Ministry of Health of Russia, Baturin V.A. ,   MD, Professor, Head of the Department of Clinical Pharmacology, with the course of DPO of Stavropol State Medical University, Federal State Educational Institution of the Ministry of Health of Russia, Muravyeva A.A. ,   PhD, assistant of professor of the Department of Department of Anesthesiology and Intensive care with a course of additional professorial education of Stavropol State Medical University,  Federal State Educational Institution of the Ministry of Health of Russia, Massorov V.V. ,   resident of the department of Anesthesiology and Intensive care with a course of additional professorial education of Stavropol State Medical University, Federal State Educational Institution of the Ministry of Health of Russia
Published: January 2025

Aim: to evaluate the results of clinical studies devoted to the study of the role of endothelial glycocalyx (GC) in the pathogenesis of critical conditions.
Materials and Methods. Scientific information was searched in domestic (E-Library) and foreign databases (PubMed, Scopus, Oxford University Press, Springer, Web of Science Core Collection). 120 publications were analysed, 42 of them were selected to meet the requirements of the review.
Results. GC is a gel-like polysaccharide-protein layer covering the surface of vascular endothelial cells. GC maintains homeostasis of the vascular network, including controlling vascular permeability and microvascular tone, preventing microvascular thrombosis, and regulating leukocyte adhesion. Endothelial GC damage is a universal link of pathogenesis in various pathological processes. The proposed review considers the structure and functions of GC, its participation in the pathogenesis of such diseases as diabetes mellitus, sepsis, covid-19, polytrauma, pre-eclampsia, epilepsy and others. A decrease in GC thickness in patients with diabetes mellitus has been described. The effect of hyperglycaemia on GC structure has also been noted. In sepsis, GC is damaged by free oxygen radicals, which are released by circulating leukocytes, which in turn triggers a cascade of reactions that lead to systemic oedema, hypovolaemia with further development of organ and tissue damage. In severe trauma, damage to GC is noted, which is accompanied by the release of syndecan, heparan sulfate, hyaluronic acid into the bloodstream. Preeclampsia is also associated with GC damage, which can be detected by elevation of specific markers. Epilepsy and many other neurological diseases are associated with disruption of the blood-brain barrier, whose dysfunction is associated with GC dysfunction.
Conclusion. Timely diagnosis of GC degradation can improve life prognosis and therapeutic outcomes in critically ill patients.
Keywords: glycocalyx, sepsis, pre-eclampsia, polytrauma, status epilepticus, coronavirus infection, syndecan, hyaluronic acid.