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. 2025 Jun 11:12:1538515.
doi: 10.3389/fmed.2025.1538515. eCollection 2025.

Enhancing sepsis management: the role of dynamic heparin-binding protein monitoring in elderly patients

Lei Miao #  1 , Dandan Liu #  1 , Jingxian Liao  2 , Xiaozhu Shen  2 , Chunhui Xie  2 , Guangyun Hu  2
Affiliations

Enhancing sepsis management: the role of dynamic heparin-binding protein monitoring in elderly patients

Lei Miao et al. Front Med (Lausanne). .

Abstract

Background: Sepsis is a life-threatening condition with particularly high mortality rates among the elderly. This study investigates the dynamic monitoring of heparin-binding protein (HBP) levels as prognostic biomarkers to improve risk stratification and management in elderly septic patients.

Methods: We conducted a retrospective cohort study involving patients aged 65 and older who were hospitalized for sepsis. Data were extracted from electronic medical records, including demographic, clinical, and laboratory information. We analyzed the relationship between dynamic HBP levels and 28-day mortality using linear mixed-effects models to assess the effects of time and prognostic groups.

Results: Among 386 elderly septic patients, the 28-day mortality rate was 20.73%. HBP levels were significantly elevated at all time points in the mortality group compared to the survival group (p < 0.001). The linear mixed-effects model indicated that time, prognosis group, and their interaction significantly influenced HBP levels. In the survival group, HBP levels decreased significantly over time, whereas the mortality group exhibited a smaller reduction, with HBP levels remaining elevated overall. The prognostic predictive ability of HBP improved at various time points, with the combined model of HBP and C-reactive protein (CRP) showing time-varying area under the curve (AUC) values: 0.728 on day 10, 0.744 on day 15, and 0.803 on day 20. The time-dependent ROC curve demonstrated that the combined model consistently exhibited superior discriminative ability throughout the follow-up period. Additionally, the time-dependent Cox regression model indicated that dynamic HBP levels effectively predicted 28-day mortality risk across all subgroups (p < 0.001).

Conclusion: Dynamic monitoring of HBP levels may aid in risk stratification and support clinical decision-making. Further prospective studies are required to evaluate its clinical utility and potential impact on patient management.

Keywords: dynamic monitoring; elderly; heparin-binding protein; prognosis; sepsis.

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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
Flow diagram displaying the progress of all participants through the study.
Figure 2
Figure 2
Dynamic trend of predicted values for CRP (A) and HBP (B). CRP: C-reactive protein; HBP: Heparin-binding protein; T0: On the day of admission; T1: 24 h after admission; T2: On the third day after admission.
Figure 3
Figure 3
(A) ROC curves for HBP, CRP, and combined testing in prognostic prediction. (B) ROC curve for the relative change in HBP from baseline to Day 2 for predicting 28-day mortality. The relative change was calculated as [(HBP T2 – HBP T0)/HBP T0] × 100%. CRP: C-reactive protein; HBP: Heparin-binding protein; AUC: Area under the curve; T0: On the day of admission; T1: 24 h after admission; T2: On the third day after admission.
Figure 4
Figure 4
Comparison of time-dependent AUC values for each model at different time points. CRP: C-reactive protein; HBP: Heparin-binding protein.
Figure 5
Figure 5
Time-dependent ROC curves for different models at each time point. CRP: C-reactive protein; HBP: Heparin-binding protein.
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