{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:06:22Z","timestamp":1792807582149,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sepsis-induced disseminated intravascular coagulation (DIC) is associated with critical conditions and linked to a high mortality rate. Anticoagulants such as recombinant human soluble thrombomodulin (rhTM) and antithrombin are used to treat sepsis-associated DIC; however, their efficacy remains controversial. Syndecan-1, a biomarker of endothelial glycocalyx injury, has been proposed as a potential indicator of sepsis severity and prognosis. This study aimed to investigate the association between serum syndecan-1 levels and recovery from sepsis-associated DIC in patients treated with anticoagulants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective observational study was conducted at Gifu University Hospital. Patients aged \u2265 20\u202fyears with sepsis-associated DIC treated with anticoagulants (rhTM and antithrombin III) for \u22652\u202fdays were included. Serum syndecan-1 levels were measured at baseline, during treatment, and at 2\u202fdays after therapy. The relationship between syndecan-1 levels and recovery from DIC, assessed using the Japanese Association for Acute Medicine (JAAM)-2 and JAAM-DIC criteria, was analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen patients were included. Serum syndecan-1 levels peaked at the start of anticoagulation therapy, decreased during treatment, and increased after cessation of therapy. Recovery from DIC was associated with lower post-treatment syndecan-1 levels (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). In patients who did not recover, syndecan-1 levels increased by more than 30%, correlating with poor outcomes, including mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Syndecan-1 is a potential marker for monitoring endothelial injury and recovery from sepsis-associated DIC. Extended anticoagulant therapy may improve outcomes by reducing endothelial damage and potentially enhancing recovery from DIC in patients with sepsis. Further large-scale studies are required to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1566753","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T05:35:49Z","timestamp":1752644149000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Reevaluating anticoagulation therapy for sepsis-associated disseminated intravascular coagulation based on endothelial glycocalyx shedding quantification: a single-center, retrospective, observational pilot study"],"prefix":"10.3389","volume":"12","author":[{"given":"Keiko","family":"Suzuki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Sumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kodai","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Yoshimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shozo","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Tetsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideshi","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1111\/j.1538-7836.2004.00955.x","article-title":"Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation","volume":"2","author":"Dhainaut","year":"2004","journal-title":"J Thromb Haemost"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.imbio.2014.06.005","article-title":"Unfractionated heparin suppresses lipopolysaccharide-induced monocyte chemoattractant protein-1 expression in human microvascular endothelial cells by blocking Kr\u00fcppel-like factor 5 and nuclear factor-\u03baB pathway","volume":"219","author":"Li","year":"2014","journal-title":"Immunobiology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1055\/s-0040-1715460","article-title":"The anticoagulant and nonanticoagulant properties of heparin","volume":"120","author":"Beurskens","year":"2020","journal-title":"Thromb Haemost"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1517\/14728222.2016.1086750","article-title":"Thrombomodulin as an intravascular safeguard against inflammatory and thrombotic diseases","volume":"20","author":"Ito","year":"2016","journal-title":"Expert Opin Ther Targets"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"614545","DOI":"10.1155\/2012\/614545","article-title":"Thrombomodulin: a bifunctional modulator of inflammation and coagulation in sepsis","volume":"2012","author":"Okamoto","year":"2012","journal-title":"Crit Care Res Pract"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1160\/TH15-08-0687","article-title":"Antithrombin: anti-inflammatory properties and clinical applications","volume":"115","author":"Levy","year":"2016","journal-title":"Thromb Haemost"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1046\/j.1563-2571.2002.02012.x","article-title":"The anti-inflammatory actions of antithrombin--a review","volume":"29","author":"Wiedermann","year":"2002","journal-title":"Acta Med Austriaca"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"R272","DOI":"10.1186\/cc10553","article-title":"Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? 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