Heparin-Binding Protein Performs Better for Detecting Sepsis Among Patients Presenting With Signs of Systemic Infection Compared With Procalcitonin, C-Reactive Protein, and Lactate Level, and Heparin-Binding Protein Is Sufficient for Both Ruling in and Out Sepsis With Organ Dysfunction: Beware of Potential Confounding Factors!

The predictive value of heparin-binding protein for bacterial infections in patients with severe polytrauma

INTRODUCTION

Heparin-binding protein is an inflammatory factor with predictive value for sepsis and participates in the inflammatory response through antibacterial effects, chemotaxis, and increased vascular permeability. The role of heparin-binding protein in sepsis has been progressively demonstrated, but few studies have been conducted in the context of polytrauma combined with bacterial infections. This study aims to investigate the predictive value of heparin-binding protein for bacterial infections in patients with severe polytrauma.

MATERIALS AND METHODS

This is a prospective single-center study. Patients with polytrauma in the emergency intensive care unit were selected for the study, and plasma heparin-binding protein concentrations and other laboratory parameters were measured within 48 hours of admission to the hospital. A two-sample comparison and univariate logistic regression analysis investigated the relationship between heparin-binding protein and bacterial infection in polytrauma patients. A multifactor logistic regression model was constructed, and the ROC curve was plotted.

RESULTS

Ninety-seven patients with polytrauma were included in the study, 43 with bacterial infection and 54 without infection. Heparin-binding protein was higher in the infected group than in the control group [(32.00±3.20) ng/mL vs. (18.52±1.33) ng/mL, P = 0.001]. Univariate logistic regression analysis shows that heparin-binding protein is related to bacterial infection (OR = 1.10, Z = 3.91, 95%CI:1.05~1.15, P = 0.001). Multivariate logistic regression equations showed that patients were 1.12 times more likely to have bacterial infections for each value of heparin-binding protein increase, holding neutrophils and Procalcitonin (PCT) constant. ROC analysis shows that heparin-binding protein combined with neutrophils and PCT has better predictive value for bacterial infection [AUC = 0.935, 95%CI:0.870~0.977].

CONCLUSIONS

Heparin-binding protein may predict bacterial infection in patients with severe polytrauma. Combining heparin-binding protein, PCT, and neutrophils may improve bacterial infection prediction.

Systemic Inflammatory Status of Patients with Obstructive Sleep Apnea Syndrome and the Predictive Value of Heparin-Binding Protein

Objective: To investigate the alteration of the systemic inflammatory status of patients with obstructive sleep apnea syndrome (OSAS) and the predictive value of heparin-binding protein (HBP) for OSAS. Methods: Patients with OSAS who were hospitalized in our hospital from 2020 January to 2022 December and diagnosed by polysomnography (PSG) (OSAS group, n = 79) were retrospectively studied and their relevant examination findings and demographic characteristics were recorded. Sex- and age-matched non-OSAS patients hospitalized at the same time were selected as the control group (control group, n = 28). Differences in peripheral blood neutrophil counts, lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), and HBP were compared between the 2 groups. The predictive value of these markers for OSAS was analyzed using the receiver operating characteristic curve, and independent risk factors for OSAS were determined using logistic regression analysis. Peripheral blood was drawn from all patients in the fasting state of the morning. Results: The number of peripheral blood neutrophils, lymphocytes, and HBP was higher in the OSAS group than in the control group, and the differences were statistically significant (P all <.05), while the differences in NLR and PCT between the 2 groups were not statistically significant (P all >.05). Plasma HBP level had an area under the curve (AUC) of 0.79 (P < .0001) in determining OSAS, with a sensitivity of 80.49% and a specificity of 70.83% and the best cutoff value was >10.73 ng/ml. Combining body mass index (BMI), neutrophil, lymphocyte, and HBP improved the predictive value of OSAS with an AUC of 0.89 (P < .0001), a sensitivity of 80.49%, and a specificity of 87.50%. Logistic regression analysis showed that both BMI and HBP were independent risk factors for OSAS (PBMI < .001, PHBP < .01), while neutrophils and lymphocytes were not (P all >.05). Conclusions: This is the first study to objectively examine HBP in OSAS patients, and HBP is an independent risk factor that may serve as a diagnostic biomarker in OSAS. Patients with OSAS have an altered systemic inflammatory state and may be more prone to severe bacterial infections.

A novel HCP (heparin-binding protein-C reactive protein-procalcitonin) inflammatory composite model can predict severe acute pancreatitis

Severe acute pancreatitis (SAP) presents with an aggressive clinical presentation and high lethality rate. Early prediction of the severity of acute pancreatitis will help physicians to further precise treatment and improve intervention. This study aims to construct a composite model that can predict SAP using inflammatory markers. 212 patients with acute pancreatitis enrolled from January 2018 to June 2020 were included in this study, basic parameters at admission and 24 h after hospitalization, and laboratory results such as inflammatory markers were collected. Pearson's test was used to analyze the correlation between heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein (CRP). Risk factors affecting SAP were analyzed using multivariate logistic regression, inflammatory marker models were constructed, and subject operating curves were used to verify the discrimination of individual as well as inflammatory marker models and to find the optimal cut-off value based on the maximum Youden index. In the SAP group, the plasma levels of HBP, CRP, and PCT were 139.1 ± 74.8 ng/mL, 190.7 ± 106.3 mg/L and 46.3 ± 22.3 ng/mL, and 25.3 ± 16.0 ng/mL, 145.4 ± 67.9 mg/L and 27.9 ± 22.4 ng/mL in non-SAP patients, with a statistically significant difference between the two groups (P < 0.001), The Pearson correlation analysis showed a positive correlation between the three values of HBP, CRP, and PCT. The results of the multivariate logistic regression analysis showed that HBP (OR = 1.070 [1.044-1.098], P < 0.001), CRP (OR = 1.010 [1.004-1.016], P = 0.001), and PCT (OR = 1.030[1.007-1.053], P < 0.001) were risk factors for SAP, and the area under the curve of the HBP-CRP-PCT model was 0.963 (0.936-0.990). The HCP model, consisting of HBP, CRP, and PCT; is well differentiated and easy to use and can predict the risk of SAP in advance.