Efficacy evaluation of combined heparin-binding protein, total bilirubin, and white blood cell count in predicting sepsis in patients with severe trauma.

AIM: To evaluate the effectiveness of heparin-binding protein (HBP) in combination with organ function indicators for early diagnosis and prognosis prediction in patients with severe trauma complicated with sepsis. METHODS: A retrospective analysis was conducted on 184 patients with multiple injuries who were admitted to the Emergency Medicine Department of the Second Affiliated Hospital of Zhejiang University Medical College between January 2019 and September 2020 and underwent HBP testing. Patients were classified according to the SEPSIS 3. 0 diagnostic criteria into a sepsis group (n=89) and a non-sepsis group (n=95). Clinical outcomes were tracked, dividing patients into a deceased group (n=43) and a survival group (n=141). HBP levels were continuously measured, and the peak values of the two groups were compared to assess the efficacy of diagnosing sepsis. Further analysis on the correlation of HBP peak value median with clinical prognosis was conducted. The effectiveness of HBP alone and in combination with total bilirubin (TBil) and white blood cell (WBC) count in prognosis assessment was evaluated. RESULTS: (1) No significant difference was found in the peak level of HBP between the sepsis group (n=89) and the non-sepsis group (n=95) (71. 7± 68. 6 vs 52. 5±56. 1, P=0. 051). (2) Among the 184 patients, the peak level of HBP was positively correlated with WBC count (r=0. 244, P<0. 01) and TBil levels (r=0. 241, P<0. 01). (3) The area under curve (AUC) for independent diagnosis of sepsis using TBil levels, WBC count, and PCT levels were 0. 618, 0.631, and 0. 718, respectively, and the combined AUC was 0. 684, with a diagnostic sensitivity of 60. 7% and specificity of 71. 6% (P<0. 05). (4) Prognostic analysis of mortality showed that patients in the high HBP level group had a significantly higher mortality rate than those in the low-level group (30. 4% vs 16. 3%, P<0. 05). The WBC count was also significantly higher in the deceased group than in the survival group (17. 5±6. 9 vs 12. 8±4. 7, P<0. 01), especially in those with sepsis (P<0. 01). The AUCs for predicting sepsis mortality prognosis using HBP peak level, TBil levels, WBC count, SOFA score, and APACHE-II score were 0. 618, 0. 603, 0. 719, 0. 823, and 0. 811, respectively. The combined AUC of HBP with TBil and WBC for assessing sepsis prognosis was 0. 750, with a sensitivity of 74. 4% and specificity of 74. 5%, showing statistically significant differences (P<0. 05). (5) The combined assessment of these three indicators showed no statistically significant difference from artificial scoring systems in predicting sepsis prognosis (P>0. 05). CONCLUSION: The combination of HBP, TBil, and WBC is highly effective in predicting the risk of sepsis in patients with multiple injuries and has significant clinical value in predicting the mortality risk of trauma patients with sepsis. [ABSTRACT FROM AUTHOR]