The Value of Heparin Binding Protein in Early Identification of Sepsis-Induced Coagulopathy Disease and Prognosis.

Abstract

Background: The aim of this study was to explore the value of heparin-binding protein (HBP) in the early recognition of sepsis coagulopathy (SIC) and the prognosis of sepsis patients.

Methods: A retrospective analysis was performed for 139 patients with sepsis admitted to the Intensive Care Unit (ICU) of Hefei Third People's Hospital from April 2022 through April 2024. The clinical baseline data, disease scores [sequential organ failure (SOFA) score, acute physiology and chronic health status (APACHE II) score, and SIC score], inflammatory markers [HBP, procalcitonin (PCT), and interleukin 6 (IL-6)], coagulation-related indexes [platelet count (PLT), prothrombin time (PT), prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), and D dimer (D-D)], and the survival time and 28-day prognosis of all patients were observed. The correlation between HBP and disease scores, inflammatory indexes, and coagulation-related indexes was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of HBP for SIC and the value of HBP and SIC score for the prognosis of sepsis, the risk stratification was carried out according to the optimal cutoff value of HBP, the differences in the occurrence of major clinical events under different HBP stratifications were compared, and the Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate under different HBP stratifications.

Results: Among the 139 patients, 98 developed SIC, 41 did not, 73 died at 28 days, and 66 survived. The disease score, inflammation index, and coagulation-related indexes of the non-SIC group were better than those of the SIC group, and the disease scores, inflammation indexes, and coagulation-related indexes of the survival group were better than those of the death group. Correlation analysis showed that HBP was positively correlated with disease score and inflammation index. Coagulation-related index was positively correlated with PT, APTT, PT-INR, Fib, and D-D, and negatively correlated with PLT, among which HBP had the best correlation with disease score (HBP was best correlated with SIC, SOFA, and APACHE II scores; r = 0.818, 0.847, and 0.829, p < 0.001). ROC analysis showed that HBP had a high efficacy in identifying SIC (AUC = 0.934, sensitivity 96.9%, specificity 87.8%, p < 0.001), and the AUC of HBP and SIC score and their combination for 28-day death prediction were 0.802, 0.773, and 0.844 (p < 0.001), respectively. Compared with the HBP ≤ 118.25 ng/mL group (n = 52), the 28-day mortality rate, SIC incidence, APACHE II, and SOFA scores were higher in the HBP > 118.25 ng/mL group (n = 52) (p < 0.001). Kaplan-Meier survival curve analysis showed that the cumulative survival rate of the HBP > 118.25 ng/mL group was significantly lower than that of the HBP ≤ 118.25 ng/mL group (p < 0.001).

Conclusions: HBP has a high predictive value in the early identification of SIC and the prognosis evaluation of sepsis, and patients with sepsis with an early HBP > 118.25 ng/mL in the ICU have a higher risk of SIC and death.