Contrary to our initial hypothesis, elevated syndecan-1 levels were associated with ARDS only in a subgroup of patients with non-pulmonary sepsis, suggesting that degradation of the glycocalyx is more severe in patients with non-pulmonary sepsis, and adding to the growing body of evidence that the mechanisms underlying direct and indirect causes of ARDS are distinct. This evidence concerns the gene SDC1 and acute respiratory distress syndrome.