Serum syndecan-1 concentration in hemolysis, elevated liver enzymes, and low platelets syndrome: A case report

Ayane Nishio; Ryo Kamidani; Hideshi Okada; Keiko Suzuki; Kodai Suzuki; Takahito Miyake; Haruka Okamoto; Tomoaki Doi; Akio Suzuki; Shozo Yoshida; Shinji Ogura

doi:10.3389/fmed.2023.1111139

Serum syndecan-1 concentration in hemolysis, elevated liver enzymes, and low platelets syndrome: A case report

Front Med (Lausanne). 2023 Mar 14:10:1111139. doi: 10.3389/fmed.2023.1111139. eCollection 2023.

Authors

Ayane Nishio¹, Ryo Kamidani^{1

2}, Hideshi Okada¹, Keiko Suzuki^{3

4}, Kodai Suzuki¹, Takahito Miyake¹, Haruka Okamoto¹, Tomoaki Doi¹, Akio Suzuki⁴, Shozo Yoshida^{1

2}, Shinji Ogura¹

Affiliations

¹ Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan.
² Abuse Prevention Center, Gifu University Graduate School of Medicine, Gifu, Japan.
³ Department of Infection Control, Gifu University Graduate School of Medicine, Gifu, Japan.
⁴ Department of Pharmacy, Gifu University Hospital, Gifu, Japan.

Abstract

Background: Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome occurs in pregnant and postpartum individuals. We observed serum syndecan-1 (SDC-1) levels, which is a component of the glycocalyx, in a patient with HELLP syndrome from admission to the postpartum period and examined their association as reflecting the pathophysiology related to endothelial injury.

Case presentation: A 31-year-old primiparous female patient without a previous medical history at a gestational age of 37 weeks and 6 days was transferred to our hospital the morning after a visit to a previous hospital with headache and nausea. Elevated transaminase, platelet count, and proteinuria were noted. Head magnetic resonance imaging revealed a caudate nucleus hemorrhage and posterior reversible encephalopathy syndrome. After she delivered her newborn through an emergency cesarean section, she was admitted to the intensive care unit. On day 4 post-delivery, the patient's D-dimer concentration was elevated, and contrast-enhanced computed tomography was performed. The results indicated pulmonary embolism, and heparin administration was initiated. The serum SDC-1 level was highest on day 1 post-delivery and quickly decreased subsequently; however, it remained elevated during the postpartum period. Her condition gradually improved, and she was extubated on day 6 and discharged from the ICU on day 7 post-delivery.

Conclusion: We measured SDC-1 concentration in a patient with HELLP syndrome and found that the clinical course correlated with SDC-1 levels, indicating that SDC-1 is elevated immediately before and after pregnancy termination in patients with HELLP syndrome. Therefore, SDC-1 fluctuations, combined with the elevation of the D-dimer level, may be a potential marker for the early detection of HELLP syndrome and estimation of the syndrome's severity in the future.

Keywords: HELLP syndrome; case report; glycocalyx; syndecan-1; vascular endothelial injury.

Publication types

Case Reports