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Shock. 2019 Feb 19. doi: 10.1097/SHK.0000000000001332. [Epub ahead of print]

Heparin-Binding Protein As A Prognostic Biomarker of Sepsis and Disease Severity at The Emergency Department.

Author information

Division of Infection Medicine, Department of Clinical Sciences, Lund, Lund University, Sweden.
Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
Department of Infectious Diseases, Helsingborg General Hospital, Helsingborg, Sweden.
Division of Pediatrics, Department of Clinical Sciences, Lund, Lund University, Sweden.
Wallenberg Center for Molecular Medicine, Lund University.
Department of Emergency Medicine, Inselspital, University Hospital, Bern, Switzerland.
Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.



Rapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma-levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department.


Prospective, international multicenter, convenience sample study SETTING:: Four general emergency departments at academic centers in Sweden, Switzerland and Canada.


All emergency encounters among adults where one of the following criteria were fulfilled: a) respiratory rate >25 breaths per minute; b) heart rate >120 beats per minute; c) altered mental status; d) systolic blood pressure <100 mm Hg; e) oxygen saturation <90% without oxygen; f) oxygen saturation <93% with oxygen; g) reported oxygen saturation <90%.


None MEASUREMENTS AND MAIN RESULTS:: A total of 524 ED patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a non-infectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 hours, 54 patients (10%) were admitted to an intensive care unit (ICU), and 23 patients (4%) died within 72 hours. For the primary outcome, detection of infected-related organ dysfunction within 72 hours, the AUC for HBP was 0.73 (95% C.I. 0.68-0.78) among all patients and 0.82 (95% C.I. 0.76-0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12-24 hours) HBP had an AUC of 0.87 (95% C.I. 0.79-0.95) among all patients and 0.88 (95% C.I. 0.77-0.99) among patients confidently adjudicated to either infection or non-infection.


Among patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.

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