Lipopolysaccharide-Binding Protein for Monitoring of Postoperative Sepsis: Complemental to C-Reactive Protein or Redundant?

Abstract

IntroductionTo prospectively evaluate the performance of Lipopolysaccharide-Binding Protein (LBP) in prediction of hospital mortality and its correlation to C-reactive Protein (CRP), we studied sixty consecutive, postoperative patients with sepsis admitted to the university hospital intensive care unit.Measurements and MethodsPlasma LBP and CRP were serially measured from day(d)1 (onset of sepsis) to d14 in parallel with clinical data until d28. Predictive value and correlation of LBP and CRP were analyzed by Receiver Operating Characteristic (ROC) curve analysis and Pearson's test, respectively.Main ResultsLBP and CRP showed the highest levels on d2 or d3 after the onset of sepsis with no significant difference between survivors and nonsurvivors. Only at d7, nonsurvivors had significantly (p = .03) higher levels of CRP than survivors. Accordingly, in ROC analysis, concentration of CRP and LBP on d7 poorly discriminated survivors from nonsurvivors (area under curve = .62 and .55, respectively) without significant difference between LBP- and CRP-ROC curves for paired comparison. LBP and CRP plasma levels allocated to quartiles correlated well with each other (r2 = .95; p = .02). Likewise, changes in plasma concentrations of LBP and CRP from one observation to the next showed a marked concordance as both parameters concomitantly increased or decreased in 76% of all cases.ConclusionsDuring the first 14 days of postoperative sepsis, LBP plasma concentrations showed a time course that was very similar to CRP with a high concordance in the pattern of day-to-day changes. Furthermore, like CRP, LBP does not provide a reliable clue for outcome in this setting.

The Effect of Synthetic C-Reactive Protein on the In Vitro Immune Response of Human PBMCs Stimulated with Bacterial Reagents

“…CRP is elevated in septic patients in response to bacterial invasion, and peaks at 100 ∼ 200 mg/L approximately 48 h after the onset of sepsis or exposure of bacterial toxins [20, 21]. Native CRP is a pentraxin with a molecular weight of 115 k Da [1, 2].…”

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“…Given the delay (typically 48 -72 h) (249) and frequently false negative blood cultures (69), the potential use of circulating biomarkers for rapid detection of sepsis and predicting outcome was actively explored. Historically, procalcitonin (PC) showed the most promise for accurately separating septic from noninfectious SIRS subjects (397,421), especially after CRP failed to adequately discriminate patients (231,391,410). The initial enthusiasm for PCT was justified by consistent and strong increases of circulating PCT in adult (50,348) and pediatric (20,354) septic patients.…”

New Approaches to Sepsis: Molecular Diagnostics and Biomarkers

“…However, in another prospective study of postoperative sepsis, where the courses of procalcitonin (PCT), interleukin-6 (IL-6), and CRP were evaluated as a percent decrease from the baseline in order to predict survival at day 28 after the onset of sepsis, PCT and IL-6 levels significantly decreased in survivors from days 1 to 14, whereas CRP levels did not (278). Likewise, a study that evaluated the predictive value of CRP for hospital mortality in 60 surgical patients at the onset of sepsis revealed no significant difference between survivors and nonsurvivors (279). After pancreatic resections, CRP levels peaked on the third postoperative day and gradually decreased thereafter in unproblematic cases, whereas they remained elevated in cases with postoperative complications (297).…”