title: Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure.
abstract: OBJECTIVE
  Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure.
  
  
  METHODS
  This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days.
  
  
  RESULTS
  Median SAPS 3 was 58.8 (48-70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001) as well as with circulatory failure (p<0.001), after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality.
  
  
  CONCLUSIONS
  A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it's predictive value at the individual patient level is low.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden.|Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Tydén
authors.affiliation: Department of Cell and Molecular Biology, Lund University, Lund, Sweden.
authors.forename: Heiko
authors.initials: H
authors.lastname: Herwald
authors.affiliation: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.|The Burn Center, Department of Hand, Plastic Surgery and Intensive Care, Linköping County Council, Linköping, Sweden.
authors.forename: Folke
authors.initials: F
authors.lastname: Sjöberg
authors.affiliation: Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden.|Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Johansson
mesh_terms: D000368:Aged; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D002352:Carrier Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood*; D012769:Shock / Q000097:blood*
chemical_list: C062991:AZU1 protein, human; D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D001798:Blood Proteins; D002352:Carrier Proteins