Lipopolysaccharide-Binding Protein for Monitoring of Postoperative Sepsis: Complemental to C-Reactive Protein or Redundant?

Klaus Tschaikowsky,Giovanni G Braun,Monika Hedwig-Geissing,Joachim Schmidt,Jovanka Voyich

doi:10.1371/journal.pone.0023615

Klaus Tschaikowsky, Giovanni G Braun + Show 3 more

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https://doi.org/10.1371/journal.pone.0023615

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Journal: PLoS ONE	Publication Date: Aug 25, 2011
Citations: 42	License type: CC BY 4.0

Affiliation: University of Erlangen-Nuremberg

Abstract

IntroductionTo prospectively evaluate the performance of Lipopolysaccharide-Binding Protein (LBP) in prediction of hospital mortality and its correlation to C-reactive Protein (CRP), we studied sixty consecutive, postoperative patients with sepsis admitted to the university hospital intensive care unit.Measurements and MethodsPlasma LBP and CRP were serially measured from day(d)1 (onset of sepsis) to d14 in parallel with clinical data until d28. Predictive value and correlation of LBP and CRP were analyzed by Receiver Operating Characteristic (ROC) curve analysis and Pearson's test, respectively.Main ResultsLBP and CRP showed the highest levels on d2 or d3 after the onset of sepsis with no significant difference between survivors and nonsurvivors. Only at d7, nonsurvivors had significantly (p = .03) higher levels of CRP than survivors. Accordingly, in ROC analysis, concentration of CRP and LBP on d7 poorly discriminated survivors from nonsurvivors (area under curve = .62 and .55, respectively) without significant difference between LBP- and CRP-ROC curves for paired comparison. LBP and CRP plasma levels allocated to quartiles correlated well with each other (r2 = .95; p = .02). Likewise, changes in plasma concentrations of LBP and CRP from one observation to the next showed a marked concordance as both parameters concomitantly increased or decreased in 76% of all cases.ConclusionsDuring the first 14 days of postoperative sepsis, LBP plasma concentrations showed a time course that was very similar to CRP with a high concordance in the pattern of day-to-day changes. Furthermore, like CRP, LBP does not provide a reliable clue for outcome in this setting.

Highlights

To prospectively evaluate the performance of Lipopolysaccharide-Binding Protein (LBP) in prediction of hospital mortality and its correlation to C-reactive Protein (CRP), we studied sixty consecutive, postoperative patients with sepsis admitted to the university hospital intensive care unit
During the first 14 days of postoperative sepsis, LBP plasma concentrations showed a time course that was very similar to CRP with a high concordance in the pattern of day-to-day changes
Like CRP, LBP does not provide a reliable clue for outcome in this setting

Summary

Introduction

To prospectively evaluate the performance of Lipopolysaccharide-Binding Protein (LBP) in prediction of hospital mortality and its correlation to C-reactive Protein (CRP), we studied sixty consecutive, postoperative patients with sepsis admitted to the university hospital intensive care unit. Sepsis is still the main cause of death in surgical intensive care units with a continuously increasing incidence and a mortality rate ranging from 30% to 60% depending on sepsis severity and the days of hospital stay [1,2] Both an early diagnosis and prognosis of sepsis are of utmost importance to control efficacy of antibiotic and surgical therapy, to manage further diagnostics and interventions and to optimize cost containment. C-reactive protein (CRP) is a well established parameter to detect local infection and has been used for many years in monitoring the inflammatory response to sepsis [15,22,24]

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