Abstract Background and aims Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major determinant of poor outcome and may result from microvascular dysfunction secondary to endothelial glycocalyx degradation. This prospective observational study investigated whether glycocalyx injury is associated with DCI and six-month outcome after aSAH. Methods This prospective observational study investigated whether glycocalyx injury is associated with DCI and six-month outcome after aSAH. Thirty aSAH patients underwent sidestream darkfield imaging of the sublingual and conjunctival microcirculation. The dynamic perfused boundary region (PBRdyn), inversely related to glycocalyx thickness, was used as a marker of glycocalyx integrity. Measurements were performed six times during the first two weeks post-ictus: the first within 72 hours (T0) and the last after 14 days (T5). Results Sublingual and conjunctival PBRdyn increased significantly in two weeks-time, suggesting progressive glycocalyx impairment. Seven (23%) patients developed DCI. PBRdyn did not differ significantly between patients with and without DCI. Higher sublingual PBRdyn at T0 was associated with unfavorable six-month outcome in univariable analysis (OR 2.63, 95% CI 0.2–78.2, p = 0.02). Early sublingual glycocalyx impairment predicted unfavorable outcome (AUC 0.79, 95% CI 0.61–0.97). Conclusions Glycocalyx degradation is observed after aSAH and progresses over time. Early glycocalyx disruption after aSAH may serve as a viable non-invasive biomarker of unfavorable outcome. Conflict of interest H Schenck: nothing to declare, K Aslankurt: nothing to declare, S van Kuijk: nothing to declare, G Hoogland: nothing to declare, E Gommer: nothing to declare, W Mess: nothing to declare, I de Ridder; nothing to declare, R van Lanen; nothing to declare, O Teernstra: nothing to declare, J Dings; nothing to declare, M Veldeman: nothing to declare, M Aries: nothing to declare, M Aries: nothing to declare, H Vink: is co-founder of the GlycoCalyx Research Institute and GlycoCheck, Y Temel: nothing to declare, R Haeren: nothing to declare
Schenck et al. (Fri,) studied this question.