Dynamic changes in heparin-binding protein as a prognostic biomarker for 30-day mortality in sepsis patients in the intensive care unit

Abstract

Heparin-binding protein (HBP) has been shown to be a robust predictor of the progression to organ dysfunction from sepsis, and we hypothesized that dynamic changes in HBP may reflect the severity of sepsis. We therefore aim to investigate the predictive value of baseline HBP, 24-h, and 48-h HBP change for prediction of 30-day mortality in adult patients with sepsis. This is a prospective observational study in an intensive care unit of a tertiary center. Patients aged 20 years or older who met SEPSIS-3 criteria were prospectively enrolled from August 2019 to January 2020. Plasma levels of HBP were measured at admission, 24 h, and 48 h and dynamic changes in HBP were calculated. The Primary endpoint was 30-day mortality. We tested whether the biomarkers could enhance the predictive accuracy of a multivariable predictive model. A total of 206 patients were included in the final analysis. 48-h HBP change (HBPc-48 h) had greater predictive accuracy of area under the curve (AUC: 0.82), followed by baseline HBP (0.79), PCT (0.72), lactate (0.71), and CRP (0.65), and HBPc-24 h (0.62). Incorporation of HBPc-48 h into a clinical prediction model significantly improved the AUC from 0.85 to 0.93. HBPc-48 h may assist clinicians with clinical outcome prediction in critically ill patients with sepsis and can improve the performance of a prediction model including age, SOFA score and Charlson comorbidity index.

An immune genes signature for predicting mortality in sepsis patients

“…Studies in the past have attempted to develop models of prognosis in sepsis patients based on new biomarkers and clinical features ( 24 – 27 ). However, due to the reliability, limited results have been applied in clinical practice.…”

Distinct patterns of serum and urine macrophage migration inhibitory factor kinetics predict death in sepsis: a prospective, observational clinical study

“…Our recent meta-analysis suggested that serum MIF level can serve as a valuable diagnostic and predictive biomarker in sepsis 7 . However, previous studies about its kinetics were scarce and reported controversial results [8][9][10] , even though the importance of some other biomarkers' kinetics in sepsis has been recognized and investigated in recent studies 14,43,44 . To shed more light on the temporal changes of serum MIF in sepsis, in the present study we report its absolute levels on the initial days after ICU admission in septic patients, who were also divided into subgroups based on age, sex, and survival.…”

“…For instance, the kinetics of plasma procalcitonin was superior to a single measurement for the prediction of death in septic patients 13 . Similarly, the time-dependent change in blood heparin‑binding protein level was more accurate than its initial value for prediction of the fatal outcome in sepsis 14 .…”

Circulating protein and lipid markers of early sepsis diagnosis and prognosis: a scoping review

“…Novel protein markers have been compared to nonspecific markers such as C-reactive protein (CRP), procalcitonin (PCT), presepsin, lactate [33–36,47,48,49 ▪ ,50,75], and proinflammatory cytokines with an established association with severe infection, such as IL-6, TNF-α, and IFN-γ [45,85]. However, these analytic approaches are of limited clinical relevance as to date, there is no gold standard circulating biological marker with a consistent ability to diagnose or prognosticate sepsis outcome.…”

“…Novel protein markers have been compared to nonspecific markers such as C-reactive protein (CRP), procalcitonin (PCT), presepsin, lactate [33][34][35][36]47,48,49 & ,50,75], and proinflammatory cytokines with an established association with severe infection, such as IL-6, TNF-a, and IFN-g [45,85]. However, these analytic approaches are…”