• Fredrik Kahn, Jonas Tverring, Lisa Mellhammar, Nils Wetterberg, Anna Bläckberg, Erika Studahl, Niklas Hadorn, Robin Kahn, Susanne Nueesch, Philipp Jent, Meret E Ricklin, John Boyd, Bertil Christensson, Parham Sendi, Per Åkesson, and Adam Linder.
• Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
• Shock. 2019 Dec 1; 52 (6): e135-e145.

ObjectiveRapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department.DesignProspective, international multicenter, convenience sample study.SettingFour general emergency departments at academic centers in Sweden, Switzerland, and Canada.PatientsAll emergency encounters among adults where one of the following criteria were fulfilled: respiratory rate >25 breaths per minute; heart rate >120 beats per minute; altered mental status; systolic blood pressure <100 mm Hg; oxygen saturation <90% without oxygen; oxygen saturation <93% with oxygen; reported oxygen saturation <90%.InterventionNone.Measurements And Main ResultsA total of 524 emergency department patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a noninfectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 h, 54 patients (10%) were admitted to an intensive care unit, and 23 patients (4%) died within 72 h. For the primary outcome, detection of infected-related organ dysfunction within 72 h, the area under the receiver operating curve (AUC) for HBP was 0.73 (95% CI 0.68-0.78) among all patients and 0.82 (95% CI 0.76-0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12-24 h) HBP had an AUC of 0.87 (95% CI 0.79-0.95) among all patients and 0.88 (95% CI 0.77-0.99) among patients confidently adjudicated to either infection or noninfection.ConclusionsAmong patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.

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