Diagnostic Value Of Heparin-binding Protein For The Severity Of Traumatic Brain Injury And Post-injury Bacterial Infection

Objective:Traumatic brain injury has a high mortality and disability,and co-infection is one of its most serious complications.There is an increasing emphasis on early diagnosis of the severity of the disease and early diagnosis of co-infections.Heparin-binding protein(HBP),an acute phase inflammatory protein,plays a vital role in the progression of traumatic brain injury,and its correlation with injury severity and infection is gradually being identified.This study aimed to investigate the clinical value of heparin-binding protein in analyzing the severity of traumatic brain injury and co-infection with bacteria.This study aimed to investigate the clinical value of heparin-binding protein in analyzing the severity of traumatic brain injury and co-infection with bacteria.Methods:Clinical data were collected prospectively from September 2021 to June 2022 in patients with traumatic brain injury admitted to the Emergency Medicine Centre of the First Hospital of Shanxi Medical University(including general information,vital signs,GCS score,ISS score,laboratory indicators,whether emergency surgery was performed,and bacterial culture results of cerebrospinal fluid specimens,blood specimens and/or sputum specimens).Physical examination data from healthy volunteers at the medical examination center were also collected as healthy controls.Peripheral venous blood was collected from all study subjects within 48 hours of admission,and plasma HBP concentrations were measured.Traumatic brain injury was classified into three groups based on GCS scores: mild,moderate and severe.Patients with pathogenic culture results of bacterial infection were classified as infected,and those with negative results were classified as non-infected.Serum heparin-binding protein concentrations were statistically analyzed for correlation with the severity of traumatic brain injury,and differences in serum heparin-binding protein between healthy controls and patients with traumatic brain injury were assessed.The diagnostic value of heparin-binding protein for diagnosing bacterial infections in combination with traumatic brain injury was assessed by logistic regression analysis and subject working characteristic curves.Results:(1)General data: A total of 85 patients with traumatic brain injury and 30 healthy medical examiners were included in the study.The age of the patients with traumatic brain injury was 55.09±1.18 years,including 44 males and 41 females.The mean age of the healthy examiners was 48.87±2.85 years,and including 20 males and ten females.There were 39 bacterial infections and 46 non-infections among the patients included in the study.(2)HBP correlated with the severity of traumatic brain injury: plasma HBP concentrations were lower in healthy controls 12.63±0.81 ng/ml than traumatic brain injury 23.94±2.02 ng/ml.Plasma HBP was higher in patients with moderate traumatic brain injury than mild [(17.56±2.32)ng/ml vs.(31.19±6.79)ng/ml],and the difference was statistically significant.The difference in plasma HBP concentration between moderate and severe group was insignificant(P>0.05).(3)The predictive effect of HBP on the co-infection of traumatic brain injury: the plasma HBP concentration was greater in the infected group than in the non-infected group [(33.00±3.49)ng/ml vs.(16.27±1.61)ng/ml,P=0.001].(4)Logistic regression and ROC analysis: neutrophils and HBP were risk factors for the development of infection in patients with traumatic brain injury.The higher the concentration of plasma HBP,the higher the risk of infection in the patient[OR=1.081,95%CI(1.025-1.141),P=0.004].The area under the ROC curve(AUC)for HBP was 0.816,with a 95% confidence interval of 0.71-0.88,a sensitivity of 92.31% and a specificity of 52.17%.Conclusion:There is a correlation between plasma HBP concentration and the severity of traumatic brain injury.HBP is elevated in both infectious and noninfectious inflammatory responses,and infectious inflammation is more pronounced than noninfectious inflammation.HBP is a valuable predictor of bacterial infection in the early stages of traumatic brain injury and is an excellent complement to the existing tests.