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Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock.doc

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Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock

Linderetal.CriticalCare2012,16:R90 /content/16/3/R90 RESEARCH OpenAccess Elevatedplasmalevelsofheparin-bindingprotein inintensivecareunitpatientswithseveresepsis andsepticshock AdamLinder1*,Per?kesson1,MalinInghammar1,Carl-JohanTreutiger2,AnnaLinnér2andJonasSundén-Cullberg2 Abstract Introduction:Rapiddetectionof,andoptimizedtreatmentfor,severesepsisandsepticshockiscrucialfor successfuloutcome.Heparin-bindingprotein(HBP),apotentinducerofincreasedvascularpermeability,isa potentiallyusefulbiomarkerforpredictingoutcomeinpatientswithsevereinfections.Ouraimwastostudythe systemicreleaseanddynamicsofHBPintheplasmaofpatientswithseveresepsisandsepticshockintheICU. Methods:AprospectivestudywasconductedoftwopatientcohortstreatedintheICUatKarolinskaUniversity HospitalHuddingeinSweden.Atotalof179patientswasincluded,ofwhom151hadsepsis(126withseptic shockand25patientswithseveresepsis)and28anon-septiccriticalcondition.Bloodsampleswerecollectedat fivetimepointsduringsixdaysafteradmission. Results:HBPlevelsweresignificantlyhigherinthesepsisgroupascomparedtothecontrolgroup.Atadmission totheICU,aplasmaHBPconcentrationof≥15ng/mLand/oraHBP(ng/mL)/whitebloodcellcount(109/L)ratio of2wasfoundin87.2%and50.0%ofcriticallyillpatientswithsepsisandnon-septicillness,respectively.A lactatelevelof2.5mmol/Lwasdetectedin64.9%and56.0%ofthesamepatientgroups.Bothinthesepsis group(n=151)andinthewholegroup(n=179),plasmaHBPconcentrationsatadmissionandinthelast measuredsamplewithinthe144hourstudyperiodweresignificantlyhigheramong28-daynon-survivorsas comparedtosurvivorsandinthesepsisgroup,anelevatedHBP-levelatbaselinewasassociatedwithanincreased case-fatalityrateat28days. Conclusions:PlasmaHBPlevelsweresignificantlyhigherinpatientswithseveresepsisorsepticshockcompared topatientswithanon-septicillnessintheICU.HBPwasassociatedwithseverityofdiseaseandanelevatedHBPat admissionwasassociatedwithanincreasedriskofdeath.HBPthatrisesovertimemayidentifypatientswitha deterioratingprognosis.Thus,repeatedHBPmeasurementin