目的:本研究旨在探讨肝素结合蛋白(HBP)在脓毒症中的诊断价值,并建立将HBP与关键生物标志物和疾病相关评分相结合的脓毒症诊断模型,并准确诊断重症监护病房(ICU)中的败血症。
方法:临床回顾性横断面研究。
方法:中国三级综合教学医院.
方法:接受HBP检测或在入住ICU时采集血样的成年患者(年龄≥18岁)。
方法:HBP,C反应蛋白(CRP),降钙素原(PCT),白细胞计数(WBC),白细胞介素-6(IL-6),乳酸(LAC),记录急性生理学和慢性健康评估II(APACHEII)和序贯器官衰竭评估(SOFA)评分。
结果:在2019年3月至2021年12月之间,该研究纳入了326例患者。将患者分为非感染组(对照组),感染组,脓毒症组及脓毒性休克组以最终诊断为依据。脓毒症组和脓毒性休克组HBP水平分别为45.7和69.0ng/mL,分别,显著高于对照组(18.0ng/mL)和感染组(24.0ng/mL)(p<0.001)。HBP诊断脓毒症的曲线下面积(AUC)值为0.733,低于PCT对应的值。CRP和SOFA高于IL-6、LAC和APACHEⅡ。多因素logistic回归分析确定了HBP,PCT,CRP,IL-6和SOFA是诊断脓毒症的有价值指标。基于这些指标构建了脓毒症诊断模型,AUC为0.901,灵敏度为79.7%,特异性为86.9%。
结论:HBP可作为ICU脓毒症诊断的生物标志物。与单一指标相比,使用HBP构建的脓毒症诊断模型,PCT,CRP,IL-6和SOFA进一步增强了脓毒症的诊断性能。
OBJECTIVE: This study aims to investigate the diagnostic value of heparin-binding protein (HBP) in sepsis and develop a sepsis diagnostic model incorporating HBP with key biomarkers and disease-related scores for rapid, and accurate diagnosis of sepsis in the intensive care unit (ICU).
METHODS: Clinical retrospective cross-sectional study.
METHODS: A comprehensive teaching tertiary hospital in China.
METHODS: Adult patients (aged ≥18 years) who underwent HBP testing or whose blood samples were collected when admitted to the ICU.
METHODS: HBP, C reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), interleukin-6 (IL-6), lactate (LAC), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) score were recorded.
RESULTS: Between March 2019 and December 2021, 326 patients were enrolled in this study. The patients were categorised into a non-infection group (control group), infection group, sepsis group and septic shock group based on the final diagnosis. The HBP levels in the sepsis group and septic shock group were 45.7 and 69.0 ng/mL, respectively, which were significantly higher than those in the control group (18.0 ng/mL) and infection group (24.0 ng/mL) (p<0.001). The area under the curve (AUC) value of HBP for diagnosing sepsis was 0.733, which was lower than those corresponding to PCT, CRP and SOFA but higher than those of IL-6, LAC and APACHE II. Multivariate logistic regression analysis identified HBP, PCT, CRP, IL-6 and SOFA as valuable indicators for diagnosing sepsis. A sepsis diagnostic model was constructed based on these indicators, with an AUC of 0.901, a sensitivity of 79.7% and a specificity of 86.9%.
CONCLUSIONS: HBP could serve as a biomarker for the diagnosis of sepsis in the ICU. Compared with single indicators, the sepsis diagnostic model constructed using HBP, PCT, CRP, IL-6 and SOFA further enhanced the diagnostic performance of sepsis.