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Open Access Highly Accessed Research

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

Adam Linder1*, Per Åkesson1, Malin Inghammar1, Carl-Johan Treutiger2, Anna Linnér2 and Jonas Sundén-Cullberg2

Author Affiliations

1 Department of Clinical Sciences, Division of Infection Medicine, Klinikgatan 1, Lund University Hospital, SE-221 85 Lund, Sweden

2 Department of Medicine, Center for Infectious Diseases F59, Karolinska Institute at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden

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Critical Care 2012, 16:R90  doi:10.1186/cc11353


See related commentary by Holub and Beran, http://ccforum.com/content/16/3/133

Published: 21 May 2012

Abstract

Introduction

Rapid 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.

Methods

A 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.

Results

HBP 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.

Conclusions

Plasma 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.