Role of heparin-binding protein and brachial artery reactivity as prognostic tests in critically ill patients with sepsis

Context Early detection of severe sepsis is crucial for successful outcome. We hypothesized that the progression of sepsis to severe sepsis is preceded by vascular leakage, which may be caused by neutrophil-derived mediators such as heparin-binding protein (HBP). Also, vascular leakage can be assessed by flow-mediated dilatation (FMD) and reactive hyperemia. Thus, both HBP and brachial artery reactivity may predict the progression of sepsis to severe sepsis and septic shock. Aim The aim of the study was to identify the role of both HBP and brachial artery reactivity as predictors of morbidity and mortality in critically ill septic patients. Settings and design This is an observational prospective controlled study. Patients and methods Patients were classified into two groups. Group I included 40 patients with evident sepsis. Group II included 10 critically ill nonseptic patients who constituted the control group. HBP blood samples were collected at three time points over 6 days after admission. Brachial artery reactivity measurements were also taken. Statistical analysis Statistical analysis was carried out on a personal computer using IBM SPSS Statistics (version 22). Results Significant difference was detected between survivors and nonsurvivors in maximum sequential organ failure assessment (SOFA) score, white blood cells, HBP at baseline and that at 48 and 96 h. The receiver operating characteristic curve using baseline HBP for prediction of severe sepsis shows a sensitivity of 94.7% and a specificity of 100% at cutoff level more than 1.9 ng/ml, and that for prediction of mortality shows a sensitivity of 91.6% and specificity of 100% at levels more than 1.9 ng/ml. Highly significant difference exists between survivors and nonsurvivors in FMD, baseline velocity, hyperemic velocity, velocity difference, and postdeflation resistance index (RI). Receiver operating characteristic curve analysis for prediction of severe sepsis/septic shock using FMD showed a sensitivity of 94.7%, specificity of 100% and associated criterion 3.4% or less. Hyperemic velocity had a sensitivity of 100%, specificity of 100%, and associated criterion 39 cm/cardiac cycle or less. Conclusion Plasma HBP levels and brachial artery reactivity can predict severe sepsis and mortality in patients with sepsis.