Value of heparin-binding protein in diagnosis of bloodstream infection

doi:10.16150/j.1671-2870.2023.02.007

Abstract

Abstract:

Objective: To investigate the diagnostic value of heparin-binding protein (HBP) in bloodstream infections. Methods: Two hundred and seven inpatients with positive blood culture results and 94 inpatients with negative results admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to January 2022 were enrolled. The levels of HBP, procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), absolute neutrophil count (ANC), and neutrophil-lymphocyte count ratio (NLCR) were detected on the day of blood culture specimens were collected. The levels of each biomarker between the blood culture positive group and the negative group were compared. The comparison of HBP levels in patients with bloodstream infection between different pathogens was also conducted. The receiver operator characteristic curve (ROC curve) were used to evaluate the diagnostic effectiveness of the above biomarkers and combined detection for bloodstream infection. Results: The levels of all the biomarkers were significantly elevated in patients with positive blood culture compared with those with negative results. Moreover, HBP levels in patients infected with Gram-positive bacterial were not significantly different from those infected with Gram-negative bacterial (median 70.26 ng/mL vs 89.15 ng/mL), but both of them were significantly higher than those in patients infected with fungi (median 22.90 ng/mL). The ROC curves for the diagnosis of bloodstream infections showed that HBP demonstrated a higher area under the curve (0.742, sensitivity 66.80%, specificity 74.40%), compared with WBC (0.622, sensitivity 64.70%, specificity 59.80%), ANC (0.651, sensitivity 51.60%, specificity 75.60%) and NLCR (0.618, sensitivity 72.10%, specificity 48.80%) significantly (P<0.05). After excluding patients with malignancies or hematopoietic disorders, the diagnostic value of HBP showed a similar result (0.708, sensitivity 60.50%, specificity 78.70%). The detection of combined HBP and PCT was an optimal choose for bloodstream infection, with an area under the curve of 0.751. Conclusions: HBP possesses a significant diagnostic value for bloodstream infections, and combination of HBP and PCT may be the preferred approach for accurate diagnosis.

Key words: Bloodstream infection, Heparin-binding protein, Procalcitonin, C-reactive protein

CLC Number:

R515.3

LIN Han, ZUBAIREGULI Maimaitiabula, SU Tongxuan. Value of heparin-binding protein in diagnosis of bloodstream infection[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(02): 147-153.

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References 23

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Biomarkers	Patients with blood culture positive （n=207）	Patients with blood culture negative （n=94）	P
HBP（ng/mL）	76.13（22.90, 148.27）	15.29（7.15, 44.46）	<0.001
PCT（ng/mL）	1.01（0.33, 4.92）	0.27（0.11, 1.33）	<0.001
CRP（ng/mL）	120.80（52.00, 178.1）	52.50（13.95, 120.45）	<0.001
WBC（10⁹/L）	10.28（5.80, 14.36）	7.40（3.69, 12.43）	0.001
ANC（10⁹/L）	8.99（4.78, 12.39）	5.65（2.50, 8.96）	<0.001
NLCR	11.30（6.27, 19.04）	7.45（3.98, 13.19）	0.001

Biomarkers	Gram-negative Bacteria（n=136）	Gram-positive Bacteria（n=53）	Fungi（n=18）
HBP（ng/mL）	89.15（37.85, 168.46）^*	70.26（17.37, 141.87）^Δ	22.90（11.10, 34.64）^*Δ
PCT（ng/mL）	1.47（0.45, 7.12）^*#	0.40（0.19, 1.36）^#	0.66（0.29, 1.82）^*
CRP（mg/L）	134.40（69.18, 186.18）^*#	84.90（18.40, 150.00）^#	60.00（52.00,100.00）^*
WBC（10⁹/L）	11.48（7.13, 15.28）^*#	8.76（5.56, 13.08）^#	5.97（3.55, 11.63）^*
ANC（10⁹/L）	9.56（5.63, 13.08）^*#	7.08（4.02, 11.12）^#	4.60（2.69, 9.99）^*
NLCR	12.40（7.52, 20.91）^*#	8.79（4.50, 14.78）^#	5.34（3.80, 12.45）^*

Species	Number	Percent	HBP (ng/mL) [Median（P25, P75）]
Gram-negative bacteria
Klebsiella Pneumoniae	66	31.89%	100.77（49.09, 186.47）
Acinetobacter baumannii	23	11.11%	106.31（20.88, 149.04）
Pseudomonas aeruginosa	17	8.21%	112.07（46.35, 162.37）
Escherichia coli	16	7.73%	57.05（17.80, 113.95）
other	14	6.76%	70.99（22.92,142.62）
Gram-positive bacteria
Staphylococcus epidermidis	14	6.76%	125.04（43.53, 242.84）
Enterococcus faecalis	10	4.83%	102.44（16.45, 175.84）
Staphylococcus aureus	7	3.38%	24.59（17.00, 141.87）
Staphylococcus hominis	4	1.93%	40.79（12.94, 111.50）
other	18	8.70%	64;45（13.87, 112.43）
Fungi
Candida parapsilosis	9	4.35%	22.90（7.15, 62.23）
Candida tropicalis	4	1.93%	23.19（11.65, 156.98）
other	5	2.42%	22.90（<5.90, 45.11）

Biomarkers	AUC	Asymptotic significance	95% Confidence interval	Cut-off	Sensitivity	Specificity
HBP（ng/mL）	0.742	<0.001	0.676-0.808	38.30	66.80%	74.40%
PCT（ng/mL）	0.685	<0.001	0.614-0.757	0.24	84.70%	47.60%
CRP（mg/L）	0.680	<0.001	0.610-0.750	103.50	54.70%	74.40%
WBC（10⁹/L）	0.622^*	0.001	0.548-0.697	8.25	64.70%	59.80%
ANC	0.651^*	<0.001	0.578-0.723	8.61	51.60%	75.60%
NLCR	0.618^*	0.002	0.545-0.692	6.86	72.10%	48.80%

Biomarkers	AUC	Asymptotic significance	95% Confidence interval	Cut-off	Sensitivity	Specificity
HBP	0.708	<0.001	0.622-0.794	59.03	60.50%	78.70%
PCT	0.598	0.039	0.503-0.694	0.24	85.50%	33.40%
CRP	0.602	0.033	0.511-0.692	103.50	55.80%	66.00%
WBC	0.527	0.57	0.433-0.621	10.16	53.50%	61.70%
ANC	0.559	0.212	0.467-0.651	8.61	52.90%	66.00%
NLCR	0.554	0.257	0.461-0.647	9.93	58.70%	55.30%