The value of heparin binding protein level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients

doi:10.3877/cma.j.issn.2095-8757.2023.01.002

Abstract

Abstract:

Objective

To investigate the value of heparin binding protein (HBP) level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients.

Methods

A multi-center prospective study was used. Patients admitted to the intensive care unit (ICU) of 18 tertiary A hospitals across the country during July 2014 and March 2015 were enrolled in the study. Once patients were included in the study, they received fluid resuscitation and active treatment immediately according to the guidelines as needed. Venous blood was collected on the day of enrollment and 24 hours after enrollment, and the levels of plasma HBP, procalcitonin (PCT), and C-reactive protein (CRP) were detected. According to the sepsis 2.0 diagnostic criteria, the patients were divided into sepsis group, severe sepsis group, septic shock group and non-infectious systemic inflammatory response syndrome (SIRS) group. The gender, age, underlying diseases, acute physiology and chronic health scoreⅡ (APACHEⅡ) score, 28-day mortality, and the levels of HBP, PCT, CRP were compared among the groups. The correlation between HBP, PCT, CRP levels and APACHEⅡ score were analyzed using Spearman non parametric correlation coefficient, and the predictive value of HBP for the prognosis of patients was evaluated using survival function.

Results

A total of 295 patients were included in the study, including 124 patients with sepsis, 58 patients with severe sepsis, 73 patients with septic shock, and 40 patients with SIRS. There were differences in APACHEⅡ scores, baseline HBP, PCT and CRP levels among the groups (F=3.841; H=14.470, 44.298, 14.778; P < 0.01), and only HBP was correlated with APACHEⅡscore on the day after enrollment (r=-0.196, P < 0.05). The 28-day mortality rates in the SIRS group, sepsis group, severe sepsis group, and septic shock group were 2.50%, 2.42%, 18.97%, and 20.55%, respectively, and the survival rate of patients with HBP≥15 μg/L was higher (χ²=0.020, P < 0.05).

Conclusion

The level of HBP is correlated with the severity of disease in elderly sepsis patients. Baseline HBP can be used to predict the prognosis, and patients with baseline HBP >15 ng/mL have an increased risk of death.

Key words: Heparin binding protein, Sepsis, Elderly, Diagnosis, Prognosis, Prediction

Xiaochun Lyu, Guolong Cai, Qianghong Xu, Caibao Hu. The value of heparin binding protein level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2023, 10(01): 8-13.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlnbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8757.2023.01.002

https://zhlnbyjdzzz.cma-cmc.com.cn/EN/Y2023/V10/I01/8

Figures/Tables 3

References 32

[1]	Glickman SW, Cairns CB, Otero RM, et al. Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis[J]. Acad Emerg Med, 2010, 17(4):383-390.
[2]	Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000[J]. N Engl J Med, 2003, 348(16):1546-1554.
[3]	Sakr Y, Vincent JL, Schuerholz T, et al. Early-versus late-onset shock in European intensive care units[J]. Shock, 2007, 28(6):636-643.
[4]	Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: Results of the SOAP study[J]. Crit Care Med, 2006, 34(2):344-353.
[5]	Winters BD, Eberlein M, Leung J, et al. Long-term mortality and quality of life in sepsis: A systematic review[J]. Crit Care Med, 2010, 38(5):1276-1283.
[6]	Yende S, D'Angelo G, Kellum JA, et al. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis[J]. Am J Respir Crit Care Med, 2008, 177(11):1242-1247.
[7]	Cuthbertson BH, Elders A, Hall S, et al. Mortality and quality of life in the five years after severe sepsis[J]. Crit Care, 2013, 17(2):R70.
[8]	Murugan R, Karajala-Subramanyam V, Lee M, et al. Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival[J]. Kidney Int, 2010, 77(6):527-535.
[9]	Linder A, Fjell C, Levin A, et al. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill[J]. Am J Respir Crit Care Med, 2014, 189(9):1075-1081.
[10]	王长远，秦俭.乳酸和急性生理学及慢性健康状况评分对老年脓毒症患者预后的评估[J].中国医药，2011，6（3）：276-277.
[11]	Kramarow EA. Sepsis-related mortality among adults aged 65 and over: United States, 2019[J]. NCHS Data Brief, 2021, 422:1-8.
[12]	Fisher J, Linder A. Heparin-binding protein: A key player in the pathophysiology of organ dysfunction in sepsis[J]. J Intern Med, 2017, 281(6):562-574.
[13]	Kahn F, Tverring J, Mellhammar L, et al. Heparin-binding protein as a prognostic biomarker of sepsis and disease severity at the emergency department[J/OL]. Shock, 2019, 52(6):e135-e145.
[14]	Wu YL, Yo CH, Hsu WT, et al. Accuracy of heparin-binding protein in diagnosing sepsis: A systematic review and meta-analysis[J/OL]. Crit Care Med, 2021, 49(1):e80-e90.
[15]	Linder A, Soehnlein O, Akesson P. Roles of heparin-binding protein in bacterial infections[J]. J Innate Immun, 2010, 2(5):431-438.
[16]	Gautam N, Olofsson AM, Herwald H, et al. Heparin-binding protein (HBP/CAP37): A missing link in neutrophil-evoked alteration of vascular permeability[J]. Nat Med, 2001, 7(10):1123-1127.
[17]	Chew MS, Linder A, Santen S, et al. Increased plasma levels of heparin-binding protein in patients with shock: A prospective, cohort study[J]. Inflamm Res, 2012, 61(4):375-379.
[18]	Linder A, Arnold R, Boyd JH, et al. Heparin-binding protein measurement improves the prediction of severe infection with organ dysfunction in the emergency department[J]. Crit Care Med, 2015, 43(11):2378-2386.
[19]	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8):801-810.
[20]	Bastani A, Galens S, Rocchini A, et al. ED identification of patients with severe sepsis/septic shock decreases mortality in a community hospital[J]. Am J Emerg Med, 2012, 30(8):1561-1566.
[21]	Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock[J]. Crit Care Med, 2006, 34(6):1589-1596.
[22]	Rivers EP, Katranji M, Jaehne KA, et al. Early interventions in severe sepsis and septic shock: A review of the evidence one decade later[J]. Minerva Anestesiol, 2012, 78(6):712-724.
[23]	Bentzer P, Fisher J, Kong HJ, et al. Heparin-binding protein is important for vascular leak in sepsis[J]. Intensive Care Med Exp, 2016, 4(1):33.
[24]	Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8):1637-1642.
[25]	Villar J, Pérez-Méndez L, Espinosa E, et al. Serum lipopolysaccharide binding protein levels predict severity of lung injury and mortality in patients with severe sepsis[J/OL]. PLoS One, 2009, 4(8):e6818.
[26]	Shapiro NI, Trzeciak S, Hollander JE, et al. A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis[J]. Crit Care Med, 2009, 37(1):96-104.
[27]	Shafer WM, Martin LE, Spitznagel JK. Cationic antimicrobial proteins isolated from human neutrophil granulocytes in the presence of diisopropyl fluorophosphate[J]. Infect Immun, 1984, 45:29-35.
[28]	Tverring J, Vaara ST, Fisher J, et al. Heparin-binding protein (HBP) improves prediction of sepsis-related acute kidney injury[J]. Annals of Intensive Care, 2017, 7(1):105.
[29]	Tydén J, Herwald H, Sjöberg F, et al. Increased plasma levels of heparin-binding protein on admission to intensive care are associated with respiratory and circulatory failure[J]. PLOS ONE, 2016, 11(3):e0152035.
[30]	Dankiewicz J, Linder A, Annborn M, et al. Heparin-binding protein: An early indicator of critical illness and predictor of outcome in cardiac arrest[J]. Resuscitation, 2013, 84(7):935-939.
[31]	Linder A, Christensson B, Herwald H, et al. Heparin-binding protein: An early marker of circulatory failure in sepsis[J]. Clin Infect Dis, 2009, 49(7):1044-1050.
[32]	Linder A, Åkesson P, Inghammar M, et al. Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock[J]. Crit Care, 2012, 16(3):R90.

组别	例数	男性	年龄（岁）	基础疾病
组别	例数	男性	年龄（岁）	糖尿病	冠心病	高血压	慢性肺疾病
SIRS组	40	30（75.0）	66±19	7（17.5）	6（15.0）	18（45.0）	7（17.5）
脓毒症组	124	95（76.6）	68±17	19（15.3）	27（21.8）	37（29.8）	37（29.8）
严重脓毒症组	58	38（65.5）	65±17	8（13.8）	9（15.5）	26（44.8）	16（27.6）
脓毒症休克组	73	52（71.2）	66±15	11（15.1）	12（16.4）	25（34.2）	17（23.3）
检验值		χ²=2.647	F=2.661	χ²=0.253	χ²=1.778	χ²=4.192	χ²=3.002
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	基础疾病				APACHEⅡ评分
组别	例数	肾脏疾病	肝胆疾病	长期使用激素	使用免疫抑制剂	APACHEⅡ评分
SIRS组	40	3（7.5）	3（7.5）	3（7.5）	2（5.0）	19.88±5.83
脓毒症组	124	18（14.5）	8（6.5）	4（3.2）	3（2.4）	17.93±7.67
严重脓毒症组	58	9（15.5）	6（10.3）	6（10.3）	2（3.4）	19.90±7.90
脓毒症休克组	73	7（9.6）	7（9.6）	2（2.7）	22（2.7）	19.61±7.50
检验值		χ²=2.541	χ²=1.153	χ²=5.510	χ²=0.733	F=3.841
P值		>0.05	>0.05	>0.05	>0.05	<0.01

组别	例数	男性	年龄（岁）	基础疾病
组别	例数	男性	年龄（岁）	糖尿病	冠心病	高血压	慢性肺疾病
SIRS组	40	30（75.0）	66±19	7（17.5）	6（15.0）	18（45.0）	7（17.5）
脓毒症组	124	95（76.6）	68±17	19（15.3）	27（21.8）	37（29.8）	37（29.8）
严重脓毒症组	58	38（65.5）	65±17	8（13.8）	9（15.5）	26（44.8）	16（27.6）
脓毒症休克组	73	52（71.2）	66±15	11（15.1）	12（16.4）	25（34.2）	17（23.3）
检验值		χ²=2.647	F=2.661	χ²=0.253	χ²=1.778	χ²=4.192	χ²=3.002
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	基础疾病				APACHEⅡ评分
组别	例数	肾脏疾病	肝胆疾病	长期使用激素	使用免疫抑制剂	APACHEⅡ评分
SIRS组	40	3（7.5）	3（7.5）	3（7.5）	2（5.0）	19.88±5.83
脓毒症组	124	18（14.5）	8（6.5）	4（3.2）	3（2.4）	17.93±7.67
严重脓毒症组	58	9（15.5）	6（10.3）	6（10.3）	2（3.4）	19.90±7.90
脓毒症休克组	73	7（9.6）	7（9.6）	2（2.7）	22（2.7）	19.61±7.50
检验值		χ²=2.541	χ²=1.153	χ²=5.510	χ²=0.733	F=3.841
P值		>0.05	>0.05	>0.05	>0.05	<0.01

组别	例数	HBP（ng/mL）	PCT（μg/L）	CRP（mg/L）
SIRS组	40	61.384（30.863，109.097）	1.010（0.160，4.290）	65.190（25.080，122.845）
脓毒症组	124	30.348（11.538，77.407）	0.460（0.140，1.400）	53.160（18.853，108.278）
严重脓毒症组	58	65.112（18.185，157.750）	1.955（0.495，7.823）	101.880（51.460，160.910）
脓毒症休克组	73	49.586（18.135，149.939）	3.120（1.250，12.840）	93.880（38.530，142.730）
H值		14.470	44.298	14.778
P值		<0.01	<0.01	<0.01

组别	例数	HBP（ng/mL）	PCT（μg/L）	CRP（mg/L）
SIRS组	40	61.384（30.863，109.097）	1.010（0.160，4.290）	65.190（25.080，122.845）
脓毒症组	124	30.348（11.538，77.407）	0.460（0.140，1.400）	53.160（18.853，108.278）
严重脓毒症组	58	65.112（18.185，157.750）	1.955（0.495，7.823）	101.880（51.460，160.910）
脓毒症休克组	73	49.586（18.135，149.939）	3.120（1.250，12.840）	93.880（38.530，142.730）
H值		14.470	44.298	14.778
P值		<0.01	<0.01	<0.01

Please choose a citation manager

Content to export