Though it seems counterintuitive that increasing injury severity is associated with progressive hypocoagulability and hyperfibrinolysis[28, 29], this may from an evolutionary perspective exert a survival advantage by preserving blood flow through the progressively more damaged and procoagulant microvasculature[28] In alignment with this, we found that in trauma patients upon hospital admission, a high level of syndecan-1, a marker of endothelial glycocalyx degradation, was associated with high sympathoadrenal activity and increased mortality, even after adjusting for injury severity score[30].