Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
BMJ Open. 2024 Jun 10;14(6):e078687. doi: 10.1136/bmjopen-2023-078687.
This study aims to investigate the diagnostic value of heparin-binding protein (HBP) in sepsis and develop a sepsis diagnostic model incorporating HBP with key biomarkers and disease-related scores for rapid, and accurate diagnosis of sepsis in the intensive care unit (ICU).
Clinical retrospective cross-sectional study.
A comprehensive teaching tertiary hospital in China.
Adult patients (aged ≥18 years) who underwent HBP testing or whose blood samples were collected when admitted to the ICU.
HBP, C reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), interleukin-6 (IL-6), lactate (LAC), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) score were recorded.
Between March 2019 and December 2021, 326 patients were enrolled in this study. The patients were categorised into a non-infection group (control group), infection group, sepsis group and septic shock group based on the final diagnosis. The HBP levels in the sepsis group and septic shock group were 45.7 and 69.0 ng/mL, respectively, which were significantly higher than those in the control group (18.0 ng/mL) and infection group (24.0 ng/mL) (p<0.001). The area under the curve (AUC) value of HBP for diagnosing sepsis was 0.733, which was lower than those corresponding to PCT, CRP and SOFA but higher than those of IL-6, LAC and APACHE II. Multivariate logistic regression analysis identified HBP, PCT, CRP, IL-6 and SOFA as valuable indicators for diagnosing sepsis. A sepsis diagnostic model was constructed based on these indicators, with an AUC of 0.901, a sensitivity of 79.7% and a specificity of 86.9%.
HBP could serve as a biomarker for the diagnosis of sepsis in the ICU. Compared with single indicators, the sepsis diagnostic model constructed using HBP, PCT, CRP, IL-6 and SOFA further enhanced the diagnostic performance of sepsis.
本研究旨在探讨肝素结合蛋白（HBP）在脓毒症中的诊断价值，并建立一种包含 HBP 与关键生物标志物和疾病相关评分的脓毒症诊断模型，以快速、准确地诊断重症监护病房（ICU）中的脓毒症。
临床回顾性横断面研究。
中国一家综合性教学三级医院。
接受 HBP 检测或入住 ICU 时采集血液样本的成年患者（年龄≥18 岁）。
记录 HBP、C 反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）、白细胞介素-6（IL-6）、乳酸（LAC）、急性生理学与慢性健康评估 II 评分（APACHE II）和序贯器官衰竭评估（SOFA）评分。
2019 年 3 月至 2021 年 12 月，共纳入 326 例患者。根据最终诊断，患者被分为非感染组（对照组）、感染组、脓毒症组和脓毒性休克组。脓毒症组和脓毒性休克组的 HBP 水平分别为 45.7 和 69.0 ng/mL，明显高于对照组（18.0 ng/mL）和感染组（24.0 ng/mL）（均 P<0.001）。HBP 诊断脓毒症的曲线下面积（AUC）值为 0.733，低于 PCT、CRP 和 SOFA，但高于 IL-6、LAC 和 APACHE II。多因素 logistic 回归分析确定 HBP、PCT、CRP、IL-6 和 SOFA 是诊断脓毒症的有价值指标。基于这些指标构建了一个脓毒症诊断模型，其 AUC 为 0.901，灵敏度为 79.7%，特异性为 86.9%。
HBP 可作为 ICU 中脓毒症的诊断标志物。与单一指标相比，基于 HBP、PCT、CRP、IL-6 和 SOFA 构建的脓毒症诊断模型进一步提高了脓毒症的诊断性能。
