Study on the prognostic value of plasma heparin-binding protein in the early diagnosis and prognosis of sepsis

doi:10.3877/cma.j.issn.2096-1537.2023.02.007

Abstract

Abstract:

Objective

To evaluate the value of plasma heparin binding protein (HBP) in the early diagnosis of sepsis, and to explore the application value of HBP for the severity and prognosis assessment of sepsis.

Methods

A prospective observational study was conducted in Department of Critical Care Medicine of Northern Jiangsu People's Hospital. One hundred and ninety-eight patients with confirmed infections from June 2019 to June 2021 were enrolled in this study. According to the illness severity of sepsis, patients were assigned as non-sepsis (n=48), sepsis (n=52) and septic shock (n=98). Forty patients in the same period without infection were selected as control group. The differences in HBP, procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and lactate (Lac) levels were compared and analyzed. The prognostic values on sepsis diagnosis and 28-day mortality were evaluated through drawing receiver operating characteristic (ROC) curve. Logistic regression analysis was used to clarify the factors affecting the prognosis of sepsis.

Results

The plasma level of HBP was obviously elevated in septic shock group than patients in other three groups (P＜0.05), while patients in sepsis group had higher HBP than patients in non-sepsis group (P＜0.05). Take an optimal cutoff value of 35.8 ng/ml, the area under the curve (AUC) for HBP to distinguish sepsis from from non-sepsis was 0.922. The levels of HBP and Lac were also significantly elevated in non-survivors compared to survival group (P＜0.05). Ho sever, no significant differences of PCT, CRP and WBC levels were found between the two groups. Plasma HBP＞97.6 ng/ml was associated with elevated mortality, AUC of HBP predicting 28-day mortality of sepsis patients was 0.750, with a sensitivity of 65.5% and a specificity of 77.7%. The plasma HBP levels in death group were higher than those in survival group at 0 h, 24 h, 48 h and 72 h after admission (P＜0.05). Meanwhile, in death group, the plasma HBP level showed no statistical differences in each time point compared with that in the previous time point (P＞0.05).

Conclusion

HBP can be a better and more specific early predictor of sepsis compared with PCT, CRP, WBC and Lactate. Meanwhile, the level and tendency of HBP has valuable to evaluate the severity of sepsis and mortality.

Key words: Heparin-binding protein, Sepsis, Septic shock, Biomarkers

Xing Cai, Wenjuan Zhang, Jiangquan Yu, Ruiqiang Zheng. Study on the prognostic value of plasma heparin-binding protein in the early diagnosis and prognosis of sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 168-177.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2023.02.007

https://icu.cma-cmc.com.cn/EN/Y2023/V09/I02/168

Figures/Tables 10

一般资料	对照组（40例）	非脓毒症组（48例）	脓毒症组（52例）	脓毒症休克组（98例）	统计值	P值
年龄（岁， $x ¯$ ±s）	62.7±6.0	60.6±10.5	62.9±10.0	63.6±9.5	F=1.095	0.352
性别［男，例（%）］	18（45.0）	24（50.0）	32（61.5）	52（53.1）	χ²=2.722	0.736
基础疾病［例（%）］
高血压	10（25.0）	17（35.4）	12（23.1）	28（28.6）	χ²=2.120	0.548
糖尿病	7（17.5）	11（22.9）	13（25.0）	31（31.6）	χ²=3.378	0.337
冠心病	5（12.5）	8（16.7）	6（11.5）	19（19.4）	χ²=1.991	0.574
感染来源［例（%）］
呼吸系统	-	32（66.7）	27（51.9）	50（51.0）	χ²=3.466	0.177
腹腔脏器	-	4（8.3）	8（15.4）	15（15.3）	χ²=1.513	0.469
泌尿系统	-	7（14.6）	10（19.2）	16（16.3）	χ²=0.404	0.817
血流感染	-	0	3（5.8）	8（8.2）	χ²=4.098	0.129
其他	-	5（10.4）	4（7.7）	9（9.2）	χ²=0.226	0.893
APACHEⅡ评分（分， $x ¯$ ±s）	14.7±5.3	15.9±4.9	16.5±3.8	22.1±6.2	F=27.088	＜0.001

一般资料	对照组（40例）	非脓毒症组（48例）	脓毒症组（52例）	脓毒症休克组（98例）	统计值	P值
年龄（岁， $x ¯$ ±s）	62.7±6.0	60.6±10.5	62.9±10.0	63.6±9.5	F=1.095	0.352
性别［男，例（%）］	18（45.0）	24（50.0）	32（61.5）	52（53.1）	χ²=2.722	0.736
基础疾病［例（%）］
高血压	10（25.0）	17（35.4）	12（23.1）	28（28.6）	χ²=2.120	0.548
糖尿病	7（17.5）	11（22.9）	13（25.0）	31（31.6）	χ²=3.378	0.337
冠心病	5（12.5）	8（16.7）	6（11.5）	19（19.4）	χ²=1.991	0.574
感染来源［例（%）］
呼吸系统	-	32（66.7）	27（51.9）	50（51.0）	χ²=3.466	0.177
腹腔脏器	-	4（8.3）	8（15.4）	15（15.3）	χ²=1.513	0.469
泌尿系统	-	7（14.6）	10（19.2）	16（16.3）	χ²=0.404	0.817
血流感染	-	0	3（5.8）	8（8.2）	χ²=4.098	0.129
其他	-	5（10.4）	4（7.7）	9（9.2）	χ²=0.226	0.893
APACHEⅡ评分（分， $x ¯$ ±s）	14.7±5.3	15.9±4.9	16.5±3.8	22.1±6.2	F=27.088	＜0.001

组别	例数	HBP（ng/ml）	PCT（ng/ml）	CRP（mg/L）	WBC（×10⁹/L）	Lac（mmol/L）
对照组	40	7.6（5.9，10.8）	0.6（0.2，1.0）	11.0（9.1，16.9）	9.9（1.7，11.3）	2.1（1.6，2.9）
非脓毒症组	48	16.3（5.9，31.2）^a	1.3（0.5，2.9）^a	44.5（34.0，64.5）^a	11.2（7.7，13.4）	1.6（1.1，2.5）
脓毒症组	52	36.1（29.9，45.9）^ab	8.1（2.6，23.0）^ab	62.1（45.3，77.8）^ab	14.8（7.7，19.7）^ab	2.4（1.6，3.9）^ab
脓毒症休克组	98	86.9（54.9，131.0）^abc	32.5（16.7，62.0）^abc	101.7（74.8，144.3）^abc	14.8（9.9，23.8）^ab	3.2（2.3，7.0）^abc
H值		168.727	145.241	162.460	26.029	41.925
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	0 h	24 h	48 h	72 h	H值	P值
非脓毒症组	48	16.3（5.9，31.2）	11.4（5.9，20.8）	10.8（5.9，16.1）	5.9（5.9，8.4）	30.616	＜0.001
脓毒症组	52	36.1（29.9，45.9）^a	30.6（21.4，34.9）^a	21.0（15.2，31.2）^a	10.7（9.3，19.8）^a	77.260	＜0.001
脓毒症休克组	98	86.9（55.0，131.0）^ab	56.0（35.8，89.3）^ab	43.1（24.8，72.9）^ab	24.6（16.2，46.7）^ab	106.611	＜0.001
H值		113.882	109.381	85.532	110.478
P值		＜0.001	＜0.001	＜0.001	＜0.001

感染指标	临界值	敏感度（%）	特异度（%）	AUC	95%CI	P值
HBP	35.8 ng/ml	84.7	87.5	0.922	0.873~0.971	＜0.001
PCT	3.58 ng/ml	85.3	81.2	0.899	0.851~0.947	＜0.001
CRP	66.5 mg/L	72.7	83.3	0.858	0.803~0.914	＜0.001
WBC	13.8×10⁹/L	56.0	83.7	0.671	0.598~0.744	＜0.001
Lac	1.95 mmol/L	82.7	62.5	0.728	0.634~0.821	＜0.001

组别	例数	0 h	24 h	48 h	72 h	H值	P值
死亡组	29	112.2（56.9，192.8）	86.0（50.1，129.0）	72.0（35.0，106.6）	66.0（38.5，89.0）	14.364	0.002
存活组	121	58.8（36.2，95.9）	41.0（28.5，66.0）^a	25.0（18.5，45.1）^a	17.4（10.3，24.6）^a	161.165	＜0.001
Z值		4.172	4.344	5.348	6.642
P值		＜0.001	＜0.001	＜0.001	＜0.001

影响因素	B值	S.E.值	Wald χ²值	OR	95%CI	P值
APACHEⅡ评分（分）	0.052	0.040	1.662	1.053	0.973~1.140	0.197
HBP（ng/ml）	0.008	0.003	6.569	1.008	1.002~1.014	0.010
Lac（mmol/L）	0.218	0.062	12.429	1.244	1.102~1.404	＜0.001

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