Heparin Binding Protein - An early marker of critical illness and predictor of outcome in cardiac arrest

Abstract: Purpose: The purpose of this study was to investigate plasma levels of Heparin Binding Protein (HBP) in patients with induced hypothermia after cardiac arrest (CA) and study any correlation to severity of organ failure and neurological outcome. Methods: This study included 84 consecutive patients with CA of mixed origin treated with hypothermia. Plasma samples from 7 different time points during the first 72 hours after CA were collected and analysed for HBP with ELISA. Outcomes were dichotomised: a Cerebral Performance Category scale (CPC) of 1 or 2 at six months follow-up was considered a good outcome, a CPC of 3 or higher, a poor outcome. APACHE II-scores and SOFA-scores were retrieved from the computerized system for quality assurance for intensive care. Results: At 6 and 12 hours after CA, plasma levels of HBP were significantly higher among patients with a poor outcome. A receiver operated characteristics (ROC)- analysis yielded respective areas under curve (AUC) values of 0.68 and 0.70. The 6h HBP-level correlated with APACHE II and SOFA-scores and predicted lactate elevation at 24h. Conclusions: Elevated HBP may be considered an early indicator of both organ failure and poor neurological outcome after CA. The temporal profile of HBP is suggestive of a role in the pathogenesis of hypoperfusion and shock after CA.