Serum endocan levels in patients with acute pulmonary thromboembolism

Pulmonary thromboembolism (PTE) is a life-threatening condition that occurs as a result of a clot blocking the pulmonary arterial bed. Endothelial dysfunction in the pulmonary vascular bed is one of the central factors in the pathogenesis of PTE. Endothelial cell-specific molecule 1 (endocan) is a soluble dermatan sulfate proteoglycan, which is released from lung and kidney vascular endothelial cells. Endocan is known to play a role in endothelium-dependent pathological processes. The objective of the present study was to determine serum endocan levels in patients with acute PTE and evaluate the relationship between serum endocan levels and disease severity. The study included 85 patients with acute PTE and 40 healthy control subjects. The patients with PTE were divided into three groups as: ''high risk'', ''moderate risk'' and ''low risk'', depending on clinical status, the presence of imaging findings indicating right ventricular dysfunction (echocardiography and/or computed tomography pulmonary angiography) and the results of cardiac biomarkers (troponin-I and NT-proBNP). Serum endocan levels were measured in both the patients and control subjects. Of the patients with PTE, included in the study, 35 (41.2%) were male and the mean age was 58.17±18.79 years. In terms of gender and age, there was no significant difference between the patients with PTE and the control subjects. The mean serum endocan level was significantly higher in the PTE group when compared with the control subjects (597.87±458.31 pg/mL and 167.19 ± 144.83 pg/mL, respectively, p<0.001) Serum endocan levels were significantly higher in the ''high risk'' group when compared with patients in the ''low risk'' and ''moderate risk'' groups (p<0.001 and p<0.01, respectively). Similarly, serum endocan levels were higher in the ''moderate risk'' group when compared with those in the ''low risk'' group (p<0.001). There was a negative correlation between serum endocan levels and partial oxygen pressure (r=-0.262, p=0.016), whereas a positive correlation was found between the serum endocan levels and systolic pulmonary arterial pressure (r=0.296, p=0.006). In addition, when the cut-off value for serum endocan is taken as 194.5 pg/mL in predicting PTE, sensitivity would be 80% and specificity would be 72.5%. Serum endocan levels were notably higher in patients with PTE compared with the control group and there was a correlation with the severity of the disease. Endocan can be established as a new biomarker in the detection of endothelial dysfunction in PTE and the evaluation of disease severity. Keywords: Pulmonary thromboembolism, endocan, endothelial dysfunction, biomarker.