Significance of lipopolysaccharide-binding protein (an acute phase protein) in monitoring critically ill patients.
BACKGROUND
The present study was conducted to assess the value of serum concentration of lipopolysaccharide-binding protein (LBP) in patients with systemic inflammatory response syndrome (SIRS), sepsis and septic shock with respect to its ability to differentiate between infectious and noninfectious etiologies in SIRS and to predict prognosis.


METHODS
This prospective cohort study was conducted in a multidisciplinary intensive care unit. Sixty-eight patients, admitted consecutively to the intensive care unit and who met criteria for SIRS, sepsis or septic shock were included. Serum LBP was measured using an immunochemiluminiscence assay.


RESULTS
Serum levels of LBP were significantly increased in patients with SIRS (n = 40; median 30.6 microg/ml, range 9.2-79.5 microg/ml), sepsis (n = 19; median 37.1 microg/ml, range 11.8-76.2 microg/ml) and septic shock (n = 9; median 59.7 microg/ml, range 31.1-105 microg/ml), as compared with levels in the healthy volunteers (5.1 +/- 2.2 microg/ml; P < 0.0001). Serum LBP at study entry was statistically significantly lower in patients with SIRS than in those with septic shock (P < 0.014); no statistically significant difference existed between patients with SIRS and those with sepsis (P = 0.61). Specificity and sensitivity of an LBP concentration of 29.8 microg/ml to distinguish between infectious and noninfectious etiologies for SIRS were 50% and 74.2%, respectively. There was no statistically significant difference in LBP concentration between survivors and nonsurvivors in both groups of patients. Furthermore, in septic patients the LBP response appeared to exhibit a decreased magnitude.


CONCLUSIONS
LBP is a nonspecific marker of the acute phase response and cannot be used as a diagnostic tool for differentiating between infectious and noninfectious etiologies of SIRS.
Prucha
Miroslav
M
Staff, Department of Clinical Biochemistry, Hematology and Immunology, Hospital Na Homolce, Czech Republic. miroslav.prucha@homolka.cz
Herold
Ivan
I
Zazula
Roman
R
Dubska
Ladislava
L
Dostal
Miroslav
M
Hildebrand
Thomas
T
Hyanek
Josef
J
D018806:APACHE; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D002352:Carrier Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood*; D012772:Shock, Septic / Q000097:blood*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002097:C-Reactive Protein; D002116:Calcitonin; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D000099231:Lipopolysaccharide-Binding Protein