Heparin-Binding Protein as a Prognostic Biomarker of Sepsis and Disease Severity at the Emergency Department

Abstract

Objective: Rapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department. Design: Prospective, international multicenter, convenience sample study. Setting: Four general emergency departments at academic centers in Sweden, Switzerland, and Canada. Patients: All emergency encounters among adults where one of the following criteria were fulfilled: respiratory rate >25 breaths per minute; heart rate >120 beats per minute; altered mental status; systolic blood pressure <100 mm Hg; oxygen saturation <90% without oxygen; oxygen saturation <93% with oxygen; reported oxygen saturation <90%. Intervention: None. Measurements and Main Results: A total of 524 emergency department patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a noninfectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 h, 54 patients (10%) were admitted to an intensive care unit, and 23 patients (4%) died within 72 h. For the primary outcome, detection of infected-related organ dysfunction within 72 h, the area under the receiver operating curve (AUC) for HBP was 0.73 (95% CI 0.68–0.78) among all patients and 0.82 (95% CI 0.76–0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12–24 h) HBP had an AUC of 0.87 (95% CI 0.79–0.95) among all patients and 0.88 (95% CI 0.77–0.99) among patients confidently adjudicated to either infection or noninfection. Conclusions: Among patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.

Integration of heparin-binding protein and interleukin-6 in the early prediction of respiratory failure and mortality in pneumonia by SARS-CoV-2 (COVID-19)

“…HBP was increased in the rst group signi cantly more than the other groups and levels above 15 ng/ml were prognostic of organ dysfunction. However, HBP levels of viral infections of this study were below the levels reported here for SARS-CoV-2 [9]. This observation and the fact that the presented herein evidence is the rst showing the ability to HBP to prognosticate 28-day outcome may bring two explanations: a) severe COVID-19 resembles more to bacterial sepsis than to a traditional viral infection; and/or b) HBP may be a biomarker more suitable for the prognosis of COVID-19 than bacterial sepsis.…”

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

“…Data from a multicentre, observational, convenience trial of sepsis biomarkers were used. Between 2015-2016, patients were enrolled at EDs in the study that has been described in detail elsewhere [15]. Patients who fulfilled at least one of the following requirements, were included: Respiratory rate >25 breaths per minute, heart rate >120 beats per minute, altered mental awareness, systolic blood pressure (SBP) below 100 mmHg, oxygen saturation (SaO 2 ) <90%, or <93% if ongoing treatment with oxygen.…”

“…Biomarkers included in the construction of a candidate risk stratification tool were lactate and HBP. The biomarkers lactate and HBP were selected for their prognostic abilities in sepsis and the availability of point-of-care testing [14,15]. Although in the study, HBP was analysed with Enzyme-Linked ImmunoSorbent Assay (ELISA) at a centralized laboratory.…”

Risk of bacteremia in patients presenting with shaking chills and vomiting - a prospective cohort study

“…This is a sub analysis of the HERO study (ClinicalTrials.gov NCT 02366650) [24]. The HERO study was a prospective, multicenter, observational convenience sample cohort study.…”

“…For the assessment of OD among infected patients the criteria for OD was used as previously described [24]. The definition of OD was adapted from the sepsis-2 consensus criteria although the fulfillment of two SIRS-criteria was not necessary due to the lack of validity [25,26].…”