The role of heparin &ndash; binding protein in the diagnosis and prognosis of sepsis syndrome in pediatric patients at the Philippine Children&rsquo;s Medical Center

Jesus Nazareno  J. Velasco,; Paula Pilar  G. Evangelista,

The role of heparin – binding protein in the diagnosis and prognosis of sepsis syndrome in pediatric patients at the Philippine Children’s Medical Center

Paula Pilar G. Evangelista | Jesus Nazareno J. Velasco

Abstract:

BACKGROUND: The burden of sepsis is global despite measures to improve its prompt recognition. However, there is no single reliable parameter for its early detection. Heparin-binding protein (HBP) is a new and promising biomarker for sepsis. Presently, there are no published reports in children apart from a limited study on UTI. OBJECTIVE: To evaluate the role of HBP as a diagnostic tool and prognostic marker of sepsis syndrome among pediatric patients. METHODS: This prospective cohort study enrolled pediatric patients who were categorized as SIRS or sepsis syndrome. HBP assay was determined on Day1. Likewise, blood culture was taken. A 7-day observation period using PELOD scoring was done. Final category as SIRS or sepsis syndrome was done on Day7. Statistical analysis was done to know relationship of HBP level to SIRS and sepsis. RESULTS: 106 patients were included in this study. There was statistical significance in the correlation of HBP assay with presence of growth in blood culture and toxic granulations, length of ventilator support, and development of complications including mortality. The cutoff point was >125ng/mL. Sensitivity and specificity for HBP in sepsis syndrome were 98.31% and 97.87% respectively. Positive predictive value was 98.3%. Negative predictive value was 97.9%. Positive likelihood ratio was 46.2. Negative likelihood ratio was 0.017. Risk ratio was 47.6. Subjects with HBP level of >125 ng/mL had 47.6 times the risk of having sepsis syndrome as compared to those with level <125 ng/ml. CONCLUSION & RECOMMENDATIONS: Elevated HBP level is a useful diagnostic and prognostic marker for childhood sepsis syndrome. Determination of HBP levels at different time intervals within a longer observation period may give a more accurate description of subject’s clinical improvement or progression to MODS or mortality.

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