Heparin-Binding Protein As A Prognostic Biomarker of Sepsis and Disease Severity at The Emergency Department.

Kahn, Fredrik; Tverring, Jonas; Mellhammar, Lisa; Wetterberg, Nils; Bläckberg, Anna; Studahl, Erika; Hadorn, Niklas; Kahn, Robin; Nueesch, Susanne; Jent, Philipp; Ricklin, Meret E; Boyd, John; Christensson, Bertil; Sendi, Parham; Åkesson, Per; Linder, Adam (2019). Heparin-Binding Protein As A Prognostic Biomarker of Sepsis and Disease Severity at The Emergency Department. Shock, 52(6), e135-e145. Lippincott Williams & Wilkins 10.1097/SHK.0000000000001332

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OBJECTIVE

Rapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma-levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department.

DESIGN

Prospective, international multicenter, convenience sample study SETTING:: Four general emergency departments at academic centers in Sweden, Switzerland and Canada.

PATIENTS

All emergency encounters among adults where one of the following criteria were fulfilled: a) respiratory rate >25 breaths per minute; b) heart rate >120 beats per minute; c) altered mental status; d) systolic blood pressure <100 mm Hg; e) oxygen saturation <90% without oxygen; f) oxygen saturation <93% with oxygen; g) reported oxygen saturation <90%.

INTERVENTION

None MEASUREMENTS AND MAIN RESULTS:: A total of 524 ED patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a non-infectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 hours, 54 patients (10%) were admitted to an intensive care unit (ICU), and 23 patients (4%) died within 72 hours. For the primary outcome, detection of infected-related organ dysfunction within 72 hours, the AUC for HBP was 0.73 (95% C.I. 0.68-0.78) among all patients and 0.82 (95% C.I. 0.76-0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12-24 hours) HBP had an AUC of 0.87 (95% C.I. 0.79-0.95) among all patients and 0.88 (95% C.I. 0.77-0.99) among patients confidently adjudicated to either infection or non-infection.

CONCLUSIONS

Among patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.

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