Association of Serum Endocan Levels with Metabolic Syndrome Severity Score and Predictive Increased Endothelial Dysfunction in Metabolic Syndrome Patients

Background/Objectives: Metabolic syndrome (MetS) is a complex clinical condition characterized by the coexistence of interrelated metabolic abnormalities that significantly increase the risk of cardiovascular diseases and type 2 diabetes mellitus. Endocan, an endothelial cell-specific molecule, is considered a biomarker of endothelial dysfunction and inflammation. This study aimed to evaluate the relationship between serum endocan levels and the severity of MetS, assessed using the MetS-Z score. Methods: In this study, 120 patients with MetS and 50 healthy controls were included. MetS was diagnosed according to the NCEP-ATP III criteria. The MetS-Z scores were calculated using the "MetS Severity Calculator" (https://metscalc.org). Serum levels of Endocan, sICAM-1, and sVCAM-1 were measured by ELISA method. Results: Serum levels of endocan, sICAM-1, and sVCAM-1 were significantly higher in the MetS group compared to the control group (all p< 0.001). When the MetS group was divided into tertiles based on MetS-Z scores, a stepwise and statistically significant increase was observed in the levels of endocan and other endothelial markers from the lowest to the highest tertile (p< 0.0001). Correlation analysis revealed a strong positive association between the MetS-Z score and serum endocan levels (r=0.584, p< 0.0001). ROC curve analysis showed that endocan had high diagnostic accuracy for identifying MetS (AUC=0.967, p< 0.0001), with a cutoff value of >88.0 ng/L. Conclusion: Circulating levels of Endocan were significantly increased in MetS and also were associated with the severity of MetS, suggesting that the levels of endocan may be a potential role of the cellular response to endothelial dysfunction injury in patients with MetS.