Miao Lei, Liu Dandan, Liao Jingxian, Shen Xiaozhu, Xie Chunhui, Hu Guangyun
Department of Critical Care Medicine, The Second People's Hospital of Lianyungang, Lianyungang, China.
Department of Geriatrics, The Second People's Hospital of Lianyungang, Lianyungang, China.
Front Med (Lausanne). 2025 Jun 11;12:1538515. doi: 10.3389/fmed.2025.1538515. eCollection 2025.
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.
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.
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 ( < 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 ( < 0.001).
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.
脓毒症是一种危及生命的疾病，在老年人中死亡率尤其高。本研究调查了肝素结合蛋白（HBP）水平的动态监测作为预后生物标志物，以改善老年脓毒症患者的风险分层和管理。
我们进行了一项回顾性队列研究，纳入了65岁及以上因脓毒症住院的患者。数据从电子病历中提取，包括人口统计学、临床和实验室信息。我们使用线性混合效应模型分析动态HBP水平与28天死亡率之间的关系，以评估时间和预后组的影响。
在386例老年脓毒症患者中，28天死亡率为20.73%。与存活组相比，死亡组在所有时间点的HBP水平均显著升高（<0.001）。线性混合效应模型表明，时间、预后组及其相互作用对HBP水平有显著影响。在存活组中, HBP水平随时间显著下降，而死亡组下降幅度较小，HBP水平总体上仍保持升高。HBP的预后预测能力在不同时间点有所改善，HBP与C反应蛋白（CRP）的联合模型显示曲线下随时间变化的面积（AUC）值：第10天为0.728，第15天为0.744，第20天为0.803。时间依赖性ROC曲线表明，联合模型在整个随访期内始终表现出更好的鉴别能力。此外，时间依赖性Cox回归模型表明，动态HBP水平有效预测了所有亚组的28天死亡风险（<0.001）。
HBP水平的动态监测可能有助于风险分层并支持临床决策。需要进一步的前瞻性研究来评估其临床实用性以及对患者管理的潜在影响。
