Investigating the Effect of Endothelial Glycocalyx on Early Diagnosis and Outcomes of Sepsis: A Narrative Review

A BSTRACT Sepsis is a life-threatening syndrome characterized by dysregulated host responses to infection, often leading to multi-organ dysfunction and high mortality rates. Early diagnosis remains a major clinical challenge due to the nonspecific nature of early symptoms and the delayed rise of traditional biomarkers such as procalcitonin and presepsin. The endothelial glycocalyx (EG), a dynamic protective layer on vascular endothelial cells, plays a pivotal role in maintaining vascular homeostasis and becomes rapidly degraded during sepsis. This narrative review explores the mechanistic involvement of EG damage in sepsis pathophysiology, with a focus on enzymatic degradation pathways and their clinical consequences, including vascular leakage, inflammation, and organ failure. Furthermore, we evaluate EG-derived biomarkers – particularly syndecan-1 (SDC-1) and heparan sulfate – as early diagnostic and prognostic tools. These biomarkers demonstrate superior sensitivity and specificity compared to conventional markers in identifying sepsis and predicting disease severity. By highlighting recent advances in EG biomarker research, this review underscores their translational potential for improving early detection, risk stratification, and personalized treatment strategies in sepsis care.