Usefulness Of The Heparin-binding Protein Level To Diagnose Sepsis And Septic Shock According To Sepsis-3

BackgroundAs a potential useful biomarker,heparin-binding protein(HBP)is an antimicrobial protein released by polymorphonuclears and plays a role in endothelial permeability regulation.objective1.Assess the release level of HBP in sepsis and septic shock under the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).2.Compare the diagnostic efficacy of HBP,procalcitonin(PCT),c-reactive protein(CRP)and other commonly used clinical indicators in sepsis and septic shock.Evaluate the combined diagnostic results of multiple indicators.3.Explore the difference in the release levels of HBP in patients with sepsis of different prognosis.DesignProspective cohort study.ParticipantsFrom August 2017 to November 2017,adult patients with clinically suspected sepsis at the Sir Run Run Shaw Hospital was included.According to the health status and severity of illness,the research subjects were divided into local infection,sepsis nonshock and septic shock under Sepsis-3 definitions.People underwent physical examination in the same period as healthy controls.Main outcome measuresPlasma levels of HBP,PCT,CRP,complete blood count were detected in all subjects.The clinical evaluation and prognosis were recorded.Single-factor analysis of variance was used to compare the level of biomarkers of multiple groups.Receiver operating characteristic curve(ROC)was used to assess the diagnostic capacity of each marker.Results1.HBP levels were significantly higher in patients with sepsis nonshock than in those with local infections(median 49.7 vs 11.8 ng/ml,P<0.01)at enrollment.Moreover,HBP levels in septic shock patients were significantly higher than in patients with sepsis without shock(median 153.8 vs 49.7 ng/ml,P<0.01)2.The area under the ROC(AUC)of HBP was 0.893,the optimal cut-off value was 28.1 ng/ml,giving a sensitivity of 84.9%,a specificity of 78.3%in diagnosing sepsis.It was higher than those of PCT(0.856)and of CRP(0.699)3.Moreover,the AUC of HBP was 0.760,a cut-off level for the HBP level of 103.5 ng/ml gave a sensitivity of 67.6%,a specificity of 82.1%in diagnosing septic shock.The second best was the SOFA score with an AUC of 0.656.The PCT level cannot identify septic shock(P=0.195)4.There was no significant difference between 28-d survivors and 28-d nonsurvivors with sepsis in terms of HBP(P=0.182).5.There was no significant difference in plasma HBP between septic patients infected with Gram-positive bacteria and Gram-negative bacteria(P=0.371).ConclusionsA high level of HBP in plasma is associated with sepsis,which might be a useful diagnostic marker in patients with suspected sepsis.