{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:27:13Z","timestamp":1785432433820,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016250","name":"Lithuanian University of Health Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016250","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/0069bkg23","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with endothelial glycocalyx injury and perioperative endothelial dysfunction. Syndecan-1 is commonly used as a biomarker of glycocalyx shedding, but data on its perioperative changes and their relationship with operative and patient-related factors remain limited. The aim of this study was to evaluate perioperative Syndecan-1 dynamics during coronary artery bypass grafting (CABG) with CPB and to assess associations with ischemia\u2013reperfusion exposure and patient characteristics. Materials and methods: This prospective observational study included 147 patients undergoing elective CABG with CPB. Syndecan-1 concentrations were measured at five time points: before induction of anaesthesia, immediately after aortic cross-clamp application, immediately after aortic declamping, on arrival at the ICU and 24 h after surgery. Perioperative changes were analysed using non-parametric tests, Spearman\u2019s rank correlation analysis and mixed-effects modelling. The study was registered at ClinicalTrials.gov (NCT03491163; registered on 29 March 2018). Results: Syndecan-1 concentrations changed significantly over time (p &lt; 0.001), increasing from a baseline median of 49.74 ng\/mL to a peak of 147.78 ng\/mL at ICU admission, followed by a partial decline to 65.26 ng\/mL at 24 h. Aortic cross-clamp duration was weakly but significantly associated with Syndecan-1 concentration at ICU admission (rs = 0.243, p = 0.003) and with perioperative increases from baseline to ICU admission (\u0394S4-1: rs = 0.196, p = 0.017) and from aortic clamping to ICU admission (\u0394S4-2: rs = 0.207, p = 0.012). No significant associations were observed between CPB duration and Syndecan-1 concentrations in univariable analyses. In the mixed-effects model, a significant non-linear temporal pattern of Syndecan-1 concentrations was observed (both linear and quadratic time terms, p &lt; 0.001). Male sex (\u03b2 = 0.247, p = 0.009) and aortic cross-clamp duration (\u03b2 = 0.016, p = 0.005) were independently associated with higher Syndecan-1 concentrations, whereas smoking status, age, BMI, diabetes status, EuroSCORE II, and CPB duration were not independently associated. Conclusions: Syndecan-1 concentrations increase significantly during cardiac surgery with cardiopulmonary bypass, peaking at ICU admission and partially declining within 24 h. Aortic cross-clamping duration, but not total CPB duration, showed weak associations with glycocalyx shedding. Male sex was independently associated with higher Syndecan-1 concentrations. These findings support ischemia\u2013reperfusion injury as an important contributor to endothelial glycocalyx shedding during cardiac surgery.<\/jats:p>","DOI":"10.3390\/medicina62071305","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:01:37Z","timestamp":1783339297000},"page":"1305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Syndecan-1 Dynamics During Cardiac Surgery: Associations with Operative Factors and Patient Characteristics"],"prefix":"10.3390","volume":"62","author":[{"given":"Tadas","family":"Cesnaitis","sequence":"first","affiliation":[{"name":"Heart Centre, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadas","family":"Lenkutis","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-0984","authenticated-orcid":false,"given":"Renata","family":"Paukstaitiene","sequence":"additional","affiliation":[{"name":"Health Data Scientific Analytics Centre, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasa","family":"Bukauskiene","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3862-0582","authenticated-orcid":false,"given":"Judita","family":"Andrejaitiene","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astra","family":"Vitkauskiene","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimantas","family":"Benetis","sequence":"additional","affiliation":[{"name":"Heart Centre, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00424-007-0212-8","article-title":"The endothelial glycocalyx: Composition, functions, and visualization","volume":"454","author":"Reitsma","year":"2007","journal-title":"Pflug. 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