Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
Department of clinical laboratory, Children's Hospital of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
BMC Cardiovasc Disord. 2020 Mar 11;20(1):124. doi: 10.1186/s12872-020-01406-3.
Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcomes in patients with postoperative myocardial injury-related cardiogenic shock (MIRCS). We aimed to evaluate and validate HBP as a prognostic biomarker for postoperative MIRCS.
We performed a case-control study in 792 patients undergoing cardiac surgery from January 1, 2016, to August 1, 2019, including 172 patients with postoperative MIRCS and 620 age- and sex-matched controls. The association between HBP and MIRCS was determined by multivariate logistic regression analysis. Receiver operating characteristic curves (ROCs) with area under the curve (AUC) were performed to calculate the cut-off value, sensitivity and specificity. The association between HBP and cardiac troponin T (cTnT) was determined by multivariable linear regression analysis. Blood samples were drawn from the coronary sinus and arterial line of the cardiopulmonary bypass (CPB) before aortic cross-clamping (time point 1) and 5 min after aortic declamping (time point 2).
Before aortic cross-clamping, coronary sinus HBP (HBP) showed no differences between the two groups. However, after declamping, the MIRCS group had a significantly higher sinus HBP level (HBP) than did the control group. HBP predicted MIRCS with an AUC of 0.85 (95% CI: 0.81-0.89, cut-off: 220 ng/ml, sensitivity: 92% and specificity: 70%). After adjusting for confounding factors, we found that HBP was an independent risk factor for MIRCS (OR: 7.65, 95% CI: 4.86-12.06, P < 0.01) and was positively associated with cTnT (β > 0, P < 0.01).
Elevated levels of coronary sinus HBP were useful biomarkers for predicting MIRCS after cardiac surgery.
肝素结合蛋白（HBP）是一种强有力的血管通透性增加诱导剂，是预测术后心肌损伤相关心源性休克（MIRCS）患者结局的潜在有用的生物标志物。我们旨在评估和验证 HBP 作为术后 MIRCS 的预后生物标志物。
我们对 2016 年 1 月 1 日至 2019 年 8 月 1 日期间接受心脏手术的 792 例患者进行了病例对照研究，包括 172 例术后 MIRCS 患者和 620 例年龄和性别匹配的对照组。通过多变量逻辑回归分析确定 HBP 与 MIRCS 的相关性。绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC）以确定截断值、灵敏度和特异性。通过多变量线性回归分析确定 HBP 与心脏肌钙蛋白 T（cTnT）的相关性。在主动脉阻断（时间点 1）前和主动脉开放后 5 分钟（时间点 2）从体外循环（CPB）的冠状窦和动脉线上抽取血样。
在主动脉阻断前，两组之间冠状窦 HBP（HBP）没有差异。然而，在主动脉开放后，MIRCS 组的窦 HBP 水平（HBP）明显高于对照组。HBP 预测 MIRCS 的 AUC 为 0.85（95%CI：0.81-0.89，截断值：220ng/ml，灵敏度：92%，特异性：70%）。在调整混杂因素后，我们发现 HBP 是 MIRCS 的独立危险因素（OR：7.65，95%CI：4.86-12.06，P<0.01），与 cTnT 呈正相关（β>0，P<0.01）。
升高的冠状窦 HBP 水平是预测心脏手术后 MIRCS 的有用生物标志物。
