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. 2022 Aug 11:9:926798.
doi: 10.3389/fmed.2022.926798. eCollection 2022.

Heparin-binding protein-enhanced quick SOFA score improves mortality prediction in sepsis patients

Xiaotong Han  1 , Qingli Dou  2   3 , Yimin Zhu  4 , Peng Ling  5 , Yi-Hsuan Shen  6 , Jiangping Liu  2   3 , Zhongwei Zhang  7 , Yucheng Zhou  1 , Maiying Fan  1 , Sih-Shiang Huang  8 , Chien-Chang Lee  8   9
Affiliations

Heparin-binding protein-enhanced quick SOFA score improves mortality prediction in sepsis patients

Xiaotong Han et al. Front Med (Lausanne). .

Abstract

Purpose: The Quick Sequential Organ Failure Assessment (qSOFA) score proposed by Sepsis-3 as a sepsis screening tool has shown suboptimal accuracy. Heparin-binding protein (HBP) has been shown to identify early sepsis with high accuracy. Herein, we aim to investigate whether or not HBP improves the model performance of qSOFA.

Methods: We conducted a multicenter prospective observational study of 794 adult patients who presented to the emergency department (ED) with presumed sepsis between 2018 and 2019. For each participant, serum HBP levels were measured and the hospital course was followed. The qSOFA score was used as the comparator. The data was split into a training dataset (n = 556) and a validation dataset (n = 238). The primary endpoint was 30-day all-cause mortality.

Results: Compared with survivors, non-survivors had significantly higher serum HBP levels (median: 71.5 ng/mL vs 209.5 ng/mL, p < 0.001). Serum level of HBP weakly correlated with qSOFA class (r 2 = 0.240, p < 0.001). Compared with the qSOFA model alone, the addition of admission HBP level to the qSOFA model significantly improved 30-day mortality discrimination (AUC, 0.70 vs. 0.80; P < 0.001), net reclassification improvement [26% (CI, 17-35%); P < 0.001], and integrated discrimination improvement [12% (CI, 9-14%); P < 0.001]. Addition of C-reactive protein (CRP) level or neutrophil-to-lymphocyte ratio (NLR) to qSOFA did not improve its performance. A web-based mortality risk prediction calculator was created to facilitate clinical implementation.

Conclusion: This study confirms the value of combining qSOFA and HBP in predicting sepsis mortality. The web calculator provides a user-friendly tool for clinical implementation. Further validation in different patient populations is needed before widespread application of this prediction model.

Keywords: clinical data collection; data curation; heparin-binding protein; mortality; qSOFA score; risk stratification; sepsis; web calculator conceptualization.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient inclusion and exclusion.
FIGURE 2
FIGURE 2
Boxplot showing the correlation between serum levels of HBP, CRP and NLR and the qSOFA class (0, 1, ≥ 2). HBP has the highest correlation with qSOFA class, followed by CRP or NLR.
FIGURE 3
FIGURE 3
Calibration of qSOFA, qSOFA-NLR, qSOFA-CRP and qSOFA-HBP. Hosmer-Lemeshow Chi-square is 0.90 for qSOFA score only (P = 0.34),3.64 for qSOFA_HBP (P = 0.30), 2.52 for qSOFA_NLR score (P = 0.47), and 7.70 for qSOFA_CRP score (P = 0.05).
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