Clinical Utility

Due to its multiple roles in the response to bacterial infection, HBP has been proposed as a potential marker for the assessment of sepsis risk in patients with early signs of an inflammatory response to infection. Several publications have demonstrated the powerful ability of HBP to predict future onset of sepsis in these infected patients:

 

Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection With Organ Dysfunction in the Emergency Department

Critical Care Medicine 2015 Nov;43(11):2378-86

This prospective observational study was performed at multiple sites in Sweden and the USA and recruited ED patients with suspected infection. 759 patients were ultimately included and their clinical progression over 72 hours was tracked. 143 patients did not have a severe form of sepsis at enrolment (defined as infection with organ dysfunction) but deteriorated over the subsequent 72 hours to develop delayed circulatory failure and/or organ dysfunction. Using the final patient diagnosis as the endpoint, the concentration at enrolment of HBP, Procalcitonin, CRP, Lactate and White Cell Count was assessed for the ability to predict this deterioration.

An elevated HBP level at enrolment was found to be the most accurate single test at predicting delayed onset of organ dysfunction within 72 hours of admission to the ED.

 

ccHBP poster jpg

Analysis of the clinical performance of each of the biomarkers showed that HBP exhibited the highest sensitivity, specificity and positive and negative predictive value of all of the markers tested:

 

IMPRESSED table

The powerful negative predictive value (NPV) of 89.5% may allow a low HBP result in a clinically stable patient with infection to be used to exclude the possibility of progression to a more severe form of sepsis.

A high HBP result in a patient with signs of an inflammatory response may indicate to the clinician that careful monitoring is needed to reduce the risk of deterioration or that initiation of the sepsis protocol is required.

 

Heparin-Binding Protein: An Early Marker of Circulatory Failure in Sepsis

Clinical Infectious Diseases 2009; 49: 1044-50

This prospective Swedish study collected plasma samples from 233 febrile adult patients with a suspected infection.

In a similar analysis to the publication above, the ability of several markers to predict deterioration of the patient was assessed.

HBP was again shown to the best single marker at predicting deterioration of the infected patient within 72 hours of enrolment.

 

Linder 2009 ROC

 

Linder 2009 table