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Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock

机译：重症脓毒症和脓毒性休克的重症监护病房患者血浆肝素结合蛋白水平升高

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IntroductionRapid detection of, and optimized treatment for, severe sepsis and septic shock is crucial for successful outcome. Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcome in patients with severe infections. Our aim was to study the systemic release and dynamics of HBP in the plasma of patients with severe sepsis and septic shock in the ICU.MethodsA prospective study was conducted of two patient cohorts treated in the ICU at Karolinska University Hospital Huddinge in Sweden. A total of 179 patients was included, of whom 151 had sepsis (126 with septic shock and 25 patients with severe sepsis) and 28 a non-septic critical condition. Blood samples were collected at five time points during six days after admission.ResultsHBP levels were significantly higher in the sepsis group as compared to the control group. At admission to the ICU, a plasma HBP concentration of ≥15 ng/mL and/or a HBP (ng/mL)/white blood cell count (109/L) ratio of >2 was found in 87.2% and 50.0% of critically ill patients with sepsis and non-septic illness, respectively. A lactate level of >2.5 mmol/L was detected in 64.9% and 56.0% of the same patient groups. Both in the sepsis group (n = 151) and in the whole group (n = 179), plasma HBP concentrations at admission and in the last measured sample within the 144 hour study period were significantly higher among 28-day non-survivors as compared to survivors and in the sepsis group, an elevated HBP-level at baseline was associated with an increased case-fatality rate at 28 days.ConclusionsPlasma HBP levels were significantly higher in patients with severe sepsis or septic shock compared to patients with a non-septic illness in the ICU. HBP was associated with severity of disease and an elevated HBP at admission was associated with an increased risk of death. HBP that rises over time may identify patients with a deteriorating prognosis. Thus, repeated HBP measurement in the ICU may help monitor treatment and predict outcome in patients with severe infections.
机译：简介快速检测严重败血症和败血性休克并对其进行优化治疗对于成功取得成功至关重要。肝素结合蛋白（HBP）是增强血管通透性的有效诱导剂，是预测严重感染患者预后的潜在有用生物标志物。我们的目的是研究ICU中严重脓毒症和败血性休克患者血浆中HBP的系统释放和动态。方法对瑞典卡林斯卡大学医院的两名患者进行了前瞻性研究。总共包括179名患者，其中151名患有败血症（126名败血症性休克患者和25名严重脓毒症患者）和28名非败血症危重病。入院后六天内的五个时间点采集血样。结果败血症组的HBP水平明显高于对照组。入ICU时，发现血浆HBP浓度≥15ng / mL和/或HBP（ng / mL）/白细胞计数（109 / L）比率> 2，分别占临界值的87.2％和50.0％患有败血症和非败血症的患者。在相同患者组中，分别有64.9％和56.0％的患者检测到乳酸水平> 2.5 mmol / L。在脓毒症组（n = 151）和整个组（n = 179）中，入院时和144小时研究期内最后测量的样本中的血浆HBP浓度在28天非存活者中均显着高于对于幸存者和败血症组，基线时HBP水平升高与28天病死率升高相关。结论脓毒症或败血性休克严重的患者血浆HBP水平明显高于非败血症的患者重症监护病房。 HBP与疾病的严重程度有关，入院时HBP升高与死亡风险增加有关。随时间升高的HBP可能会识别出预后恶化的患者。因此，在ICU中重复进行HBP测量可能有助于监测重症患者的治疗情况并预测结果。

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