Application Value Of Heparin-Binding Protein And Glycocalyx In Clinical Diagnosis Of Sepsis Coagulation Disease

ObjectiveThe mechanisms of Heparin-Binding Protein(HBP),glycocalyces and their interactions are unclear in the pathogenesis of Sepsis-induced coagulopathy(SIC).In this study,we investigated the relationship between serum levels of heparin-binding protein,glycocalyx metabolites and conventional coagulation parameters in patients with and without SIC in sepsis.The effect and predictive value of HBP released by neutrophil granulocyte and glycocalyx metabolites in SIC were investigated through the change trend of the levels of HBP and glycocalyx metabolites.The therapeutic mechanism of heparin in septic coagulation caused by HBP and glycocalyx was studied by comparing the changes of each index before and after heparin use.In order to provide theoretical basis for the treatment and prognosis of sepsis coagulation disease.MethodsA prospective study was designed to screen patients diagnosed with sepsis in the Intensive Care Department of Shanghai Oriental Hospital from November 2021 to November 2022 who met the admission criteria and were included in the study.All subjects were admitted to ICU,basic clinical data were collected,standard treatment was followed,and blood samples were taken twice before and after heparin administration for HBP,glycocalyces metabolites HA,HS,SVC-1,coagulation/fibrinolytic markers(platelet count,PT,APTT,D-dimer,and fibrinogen)and biochemical routine.ISTH dominant DIC score,SOAF score and GCS score were calculated for all enrolled patients.The ISTH dominant DIC score was divided into SIC and non-SIC groups.The differences of above blood indexes among all groups were compared and correlation analysis was conducted.ROC curve was drawn to evaluate the value of each index in predicting SIC.To compare the levels of metabolites of HBP and glycocalyx before and after heparin,and observe the significance of heparin,HBP and glycocalyx in SIC.Results1.A total of 148 subjects were screened in this study,of which 80 patients were in line with the Narrows standard.There were 24 cases in SIC group and 56 cases in non-SIC group.2.There were significant differences in plasma HBP,glycocalyx metabolites HA,HS,SDC-1 and related coagulation parameters between SIC and non-SIC groups(P<0.05);In SIC group and non-SIC group,HBP,glycocalyx metabolites were positively correlated with coagulation parameters D-Dimer,APTT and PT,while negatively correlated with PLT.3.ROC curve was established to evaluate the value of HBP,HA,HS,SDC-1,APTT and D-Dimer in predicting SIC occurrence.The results show that: HBP(AUC=0.831,sensitivity 93.8%,specificity 62.5%),HS(AUC=0.712,sensitivity 87.5%,specificity 45%),HA(AUC=0.88,sensitivity 93.8%,specificity 62.5%),SSDC-1(AUC=0.795,Sensitivity was 93.8%,specificity was 45%);APTT(AUC=0.763,sensitivity 68.8%,specificity 85%)and D-Dimer(AUC=0.883,sensitivity 100%,specificity 62.5%)were good predictors.The ROC curve combined with HBP,HS,HA,SSDC-1,APTT and D-Dimer to predict SIC showed that AUC=0.933,sensitivity was87.5%,specificity was 75%.HBP,HA,D-Dimer(AUC>0.8),which had the highest combined predictive value,were selected to establish the ROC curve,and the results showed that AUC=0.930,the sensitivity was 93%,and the specificity was 89.4%.4.After heparin treatment,HBP levels in SIC group and non-SIC group were increased,and glycocalyx metabolites levels were decreased.Compared with the non-sic group,patients in the SCI group had more significant increase in HBP level and decrease in glycocalyx metabolites.Conclusion1.The levels of HBP and glycocalyx metabolites in SIC group were higher than those in non-SIC patients,and there was a good correlation between HBP,glycocalyx metabolites and coagulation indexes in SIC and non-sic groups,as well as a good correlation between HBP and glycocalyx metabolites in the two groups.It is suggested that HBP and glycocalyx may be involved in the early process of the pathogenesis of sepsis induced sepsis coagulation disease.This provides a new diagnosis and treatment idea for combining conventional coagulation indexes to dynamically monitor the change rule of SIC and evaluate patients’ condition.2.The plasma levels of HBP and glycocalyx metabolites are good biomarkers to predict the occurrence of SIC,and the combination of HBP,glycocalyx metabolites and blood clotting indexes can more accurately predict the occurrence of early SIC.The combined use of HBP,HA and D-Dimer has high predictive value.3.After heparin treatment,the level of HBP increased,and the level of metabolites of glycocalyx decreased,and the difference between the SIC group and the non-sic group was significantly greater.This suggests that the use of heparin may protect the calyx by competitively binding HBP on the surface of the calyx,thereby protecting the endothelium and reducing the damage of SIC.