Abstract
BACKGROUNDWe aimed to investigate the prognostic value of dynamic changes in heparin-binding protein (HBP) within the first 48 hours of hospital admission in sepsis patients.MethodsWe conducted a prospective observational study in the emergency intensive care unit of a tertiary care center. Patients who met SEPSIS-3 criteria were prospectively enrolled from August 2019 to January 2020. Serum levels of HBP were measured at admission, 24 hours, and 48 hours. Dynamic change in HBP was calculated as a percentage change between admission and 24 hours, and between admission and 48 hours. Accuracies of absolute level of HBP, dynamic change of HBP, and other biomarkers were compared with ROC analysis.ResultsA total of 245 patients were enrolled. After excluding patients not fulfilling the eligibility criteria and those died before 48 hours of admission, 185 patients were included for final analysis, of which 117 had sepsis, 68(36.76%) had septic shock, and 48(30%) died in the hospital. Day 1-HBP was correlated with procalcitonin (r2=0.21, p=0.004). Of all predictors of 30-day mortality, HBP clearance within 48 hours had the highest predictive accuracy (AUC: 0.82), followed by Day 1-HBP (AUC: 0.79), PCT (AUC: 0.75) and HBPc-24(AUC: 0.6). HBPc-48 > -17.14% had an independent impact on 30-day survival after adjusting for age, gender, shock status, and requirement of mechanical ventilation support.ConclusionsHBPc-48 can predict survival in critically ill patients with sepsis and can assist clinicians with risk stratification of these patients. Future multicenter studies are necessary to assess the generalizability of these findings.
Heparin-binding protein improves prediction of severe sepsis in the emergency department
