Key result
Elevated postoperative heparin-binding protein (>41 ng/mL) was an independent predictor of 30-day mortality (OR 3.654) following cardiothoracic surgery with cardiopulmonary bypass.
Why the study?
Cardiopulmonary bypass triggers inflammation that mimics infection, and it was unknown which variables influence postoperative heparin-binding protein levels or whether elevated levels predict poor surgical outcomes.
Does elevated heparin-binding protein at ICU arrival predict 30-day mortality and poor surgical outcomes in patients undergoing cardiothoracic surgery with cardiopulmonary bypass?
Observational (n=1,475)
No
Does elevated heparin-binding protein at ICU arrival predict 30-day mortality and poor surgical outcomes in patients undergoing cardiothoracic surgery with cardiopulmonary bypass?
Odds Ratio: 3.654 (95% CI 1.243–10.744)
Absolute Event Rate: 3.5% vs 0.5%
p-value: p=0.019
Elevated heparin-binding protein (HBP) at ICU arrival following cardiothoracic surgery with cardiopulmonary bypass is an independent predictor of 30-day mortality and is influenced by surgical complexity.
Cardiothoracic surgery using cardiopulmonary bypass (CPB) triggers an inflammatory state that may be difficult to differentiate from infection. Heparin-binding protein (HBP) is a candidate biomarker for sepsis. As data indicates that HBP normalizes rapidly after cardiothoracic surgery, it may be a suitable early marker of postoperative infection. We therefore aimed to investigate which variables influence postoperative HBP levels and whether elevated HBP concentration is associated with poor surgical outcome. This exploratory, prospective, observational study enrolled 1475 patients undergoing cardiothoracic surgery using CPB, where HBP was measured at ICU arrival. Patients with HBP in the highest tercile were compared to remaining patients. Multivariable logistic regressions were performed to identify factors predictive of elevated HBP and 30-day mortality. Overall median HBP was 30.0 ng/mL. Patients undergoing isolated CABG or surgery with CPB-duration ≤ 60 min had a median HBP of 24.9 ng/mL and 23.2 ng/mL, respectively. Independent predictors of elevated postoperative HBP included increased EuroSCORE, prolonged CPB-duration and high intraoperative temperature. Increased HBP was an independent predictor of 30-day mortality. This study confirms the promising characteristics of HBP as a biomarker for identification of postoperative sepsis, especially after routine procedures. Further studies are required to investigate whether HBP may detect postoperative infections.
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Johannesson et al. (2023) conducted an observational in Cardiothoracic surgery using cardiopulmonary bypass (n=1,475). Elevated heparin-binding protein (> 41 ng/mL) vs. Heparin-binding protein ≤ 41 ng/mL was evaluated on 30-day mortality (OR 3.654, 95% CI 1.243-10.744, p=0.019). Elevated postoperative heparin-binding protein (>41 ng/mL) was an independent predictor of 30-day mortality (OR 3.654) following cardiothoracic surgery with cardiopulmonary bypass.
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