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Observational Study
. 2019 Dec;52(6):e135-e145.
doi: 10.1097/SHK.0000000000001332.

Heparin-Binding Protein as a Prognostic Biomarker of Sepsis and Disease Severity at the Emergency Department

Fredrik Kahn  1   2 , Jonas Tverring  1   3 , Lisa Mellhammar  1   2 , Nils Wetterberg  1   2 , Anna Bläckberg  1   2 , Erika Studahl  1 , Niklas Hadorn  1 , Robin Kahn  4   5 , Susanne Nueesch  6 , Philipp Jent  6   7 , Meret E Ricklin  6 , John Boyd  8 , Bertil Christensson  1   2 , Parham Sendi  7   9 , Per Åkesson  1   2 , Adam Linder  1   2
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Free article
Observational Study

Heparin-Binding Protein as a Prognostic Biomarker of Sepsis and Disease Severity at the Emergency Department

Fredrik Kahn et al. Shock. 2019 Dec.
Free article

Abstract

Objective: Rapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department.

Design: Prospective, international multicenter, convenience sample study.

Setting: Four general emergency departments at academic centers in Sweden, Switzerland, and Canada.

Patients: All emergency encounters among adults where one of the following criteria were fulfilled: respiratory rate >25 breaths per minute; heart rate >120 beats per minute; altered mental status; systolic blood pressure <100 mm Hg; oxygen saturation <90% without oxygen; oxygen saturation <93% with oxygen; reported oxygen saturation <90%.

Intervention: None.

Measurements and main results: A total of 524 emergency department patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a noninfectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 h, 54 patients (10%) were admitted to an intensive care unit, and 23 patients (4%) died within 72 h. For the primary outcome, detection of infected-related organ dysfunction within 72 h, the area under the receiver operating curve (AUC) for HBP was 0.73 (95% CI 0.68-0.78) among all patients and 0.82 (95% CI 0.76-0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12-24 h) HBP had an AUC of 0.87 (95% CI 0.79-0.95) among all patients and 0.88 (95% CI 0.77-0.99) among patients confidently adjudicated to either infection or noninfection.

Conclusions: Among patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.

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