Heparin Binding Protein An Early Marker.pdf

1044 ? CID 2009:49 (1 October) ? Linder et al M A J O R A R T I C L E Heparin-Binding Protein: An Early Marker of Circulatory Failure in Sepsis Adam Linder, Bertil Christensson, Heiko Herwald, Lars Bjo?rck, and Per A?kesson Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden Background. The early detection of circulatory failure in patients with sepsis is important for successful treatment. Heparin-binding protein (HBP), released from activated neutrophils, is a potent inducer of vascular leakage. In this study, we investigated whether plasma levels of HBP could be used as an early diagnostic marker for severe sepsis with hypotension. Methods. A prospective study of 233 febrile adult patients with a suspected infection was conducted. Patients were classified into 5 groups on the basis of systemic inflammatory response syndrome criteria, organ failure, and the final diagnosis. Blood samples obtained at enrollment were analyzed for the concentrations of HBP, procal- citonin, interleukin-6, lactate, C-reactive protein, and the number of white blood cells. Results. Twenty-six patients were diagnosed with severe sepsis and septic shock, 44 patients had severe sepsis without septic shock, 100 patients had sepsis, 43 patients had an infection without sepsis, and 20 patients had an inflammatory response caused by a noninfectious disease. A plasma HBP level
15 ng/mL was a better indicator of severe sepsis (with or without septic shock) than any other laboratory parameter investigated (sensitivity, 87.1%; specificity, 95.1%; positive predictive value, 88.4%; negative predictive value, 94.5%). Thirty-two of the 70 patients with severe sepsis were sampled for up to 12 h before signs of circulatory failure appeared, and in 29 of these patients, HBP plasma concentrations were already elevated. Conclusion. In febrile patients, high plasma levels of HBP help to identify patients with an imminent risk of developing sepsis with circulatory