Comparison of the clinical value of plasma heparin-binding protein, procalcitonin and C-reactive protein in the early diagnosis of sepsis

Abstract

Objective To assess the clinical utility of measurement of plasma heparin-binding protein (HBP) in diagnosis and prognosis of sepsis. Methods This is a retrospective study on the performance of plasma heparin-binding protein, procalcitonin and C-reaction protein in the early diagnosis of sepsis. Thirty-one patients with sepsis, 16 patients with severe sepsis, 12 patients with septic shock and 37 control patients without confirmed sepsis, all admitted to the Intensive Care Units (ICU) of the Third Hospital Affiliated to Wenzhou Medical University and Wenzhou Central Hospital from August 2014 to November 2016, were enrolled in the study. The plasma level of HBP, procalcitonin (PCT) and C-reactive protein (CRP) were measured, and the detailed clinical data were retrieved from the patient chart records for all patients described above. Comparison of each laboratory and clinical parameters between groups was carried out by Non-parameter Test. The efficiency of each parameter was calculated by receiver operating characteristics curves (ROC) analysis. The correlation between HBP, PCT or CRP and clinical or other laboratory parameters was explored using Spearman correlation analysis. Results HBP was significantly elevated in patients with severe sepsis[(100.65±58.82)ng/ml and(31.86±36.87)ng/ml, Z=-3.856, P<0.05; (100.65±58.82)ng/ml and(24.96±17.49)ng/ml, Z=-3.556, P<0.05]and in patients with septic shock[(148.28±99.73)ng/ml and(31.86±36.87)ng/ml, Z=-4.432, P<0.05; (148.28±99.73)ng/ml and(24.96±17.49)ng/ml, Z=-4.157, P<0.05], respectively, while CRP[(154.64±62.90)mg/L and(92.56±67.49)mg/L, Z=-2.749, P<0.05; (154.64±62.90)mg/L and (79.21±51.80)mg/L, Z=-3.218, P<0.05]and PCT[(32.86±39.93)ng/ml and(2.70±6.24)ng/ml, Z=-3.395, P<0.05; (32.86±39.93)ng/ml and(4.21±14.94)ng/ml, Z=-4.092, P<0.05]were increased only in patients with septic shock (P<0.05). For HBP, the area of under the ROC curves (AUC) was the biggest (AUC=0.687), indicating the clinical significance(P<0.05) with excellent sensitivity(0.729) at the optimal cut-off value(18.58 ng/ml). In addition, HBP(APTT: r=0.244, P=0.016; PT: r=0.351, P<0.001; INR: r=0.314, P=0.002; D-Dimer: r=0.334, P=0.001; lactic acid: r=0.394, P<0.001), CRP(APTT: r=0.271, P=0.008; PT: r=0.348, P=0.001; INR: r=0.264, P=0.009; D-Dimer: r=0.257, P=0.012; lactic acid: r=0.329, P=0.001) and PCT(APTT: r=0.375, P<0.001; PT: r=0.523, P<0.001; INR: r=0.535, P<0.001; D-Dimer: r=0.254, P=0.013; lactic acid: r=0.422, P<0.001)were positively correlated to coagulation function and to lactate. Conclusion HBP could probably be acted as an important biomarker for diagnosis and prognosis for patients with sepsis, esp., for patients with severe sepsis and septic shock.(Chin J Lab Med, 2017, 40: 451-455) Key words: Blood proteins; Carrier proteins; Antimicrobial cationic peptides; Sepsis; C-reactive protein; Calcitonin