The Change Of Heparin-binding Protein In Immunosuppressive Host With Severe Pneumonia

ObjectiveTo investigate the value of heparin-binding protein in evaluating severity and prognosis of immunosuppressive host with severe pneumonia.Research methodsA retrospective analysis of immunosuppressive host with pneumonia admitted to the Respiratory Intensive Care Unit(RICU)of the First Affiliated Hospital of Zhengzhou University between July 2017 and December 2018.110 patients were included in this study.According to the inclusion criteria,the patients were divided into two groups:the severe pneumonia group(SP,n=86)and the non-severe pneumonia group(NSP,n=24).Then all patients were divided into death group and survival group according to outcome of the disease.General clinical data such as age,gender,basic disease,Acute Physiology and Chronic Health Evaluation?score(APACHE?)in 24 hours of admission were recorded.And the serum HBP,white blood cell(WBC),procalcitonin(PCT)were detected within 24 hours of admission,and sputum or bronchoalveolar lavage fluid were collecting for pathogen detection.Investigate the differences of HBP,PCT,APACHE?score and WBC level between the two groups,and analysis the differences of HBP levels between positive and negative patients with pathogenic results and the differences of HBP levels between patients with different pathogen infections.Analyze the relationship between serum HBP level and severity and prognosis of the disease.Spearman correlation analysis was used to discuss the correlation between HBP,PCT,APACHE?score and WBC.The value of each index to elevate severity and prognosis of pneumonia was analyzed by receiver operating characteristic curve(ROC curve).Results1.There was no significant difference in age,gender and the disease constitution between the two groups.2.Compared to the NSP group,the SP group showed more severe condition,higher APACHE?score(NSP 10.25�5.66,SP 19.21�7.27,P<0.05),higher PCT(NSP 0.15(0.10,16.03),SP 2.67(0.67,12.34),P<0.05),higher HBP[NSP 35.09(25.96,66.56),SP 88.23(48.75,186,45),P<0.05]and higher mortality(NSP 12.50%,SP44.18%,P<0.05).There is no significant difference in WBC between two groups.compared to the surviving patients,the death patients showed more severe condition,higher APACHE?score[survival group 16(11,21),death group 18(14,22),P<0.05],higher PCT[survival group 0.70(0.25,3.79),death group 3.19(1.42,44.39),P<0.05],higher HBP[survival group 51.65(27.62,92.80),death group129.57(70.06,254.35),P<0.05]and higher mortality(NSP 12.50%,SP 44.18%,P<0.05).There is no significant difference in WBC between the two groups.3.17 patients had a leukopenia with WBC count of<4.5�10~9/L in admission,but all of them had a�positive'HBP/WBC ratio of>2.4.sputum or bronchoalveolar lavage fluid were collected in 95 patients,and 37has positive results.Compared to the positive patients,the negative patients showed lower HBP.But there is no significant difference between Gram-positive bacteria,Gram-negative bacteria and fungus.5.In SP group,serum HBP was positively correlated with PCT(the correlation coefficient is 0.281)and WBC(the correlation coefficient is 0.284).6.The ROC curve was used to analyze the case fatality rate of SP.According to the curve,the area under the curve(AUC)of HBP was the largest.Serum HBP is the most specific and sensitive for prognosis in patients with immunosuppression and severe pneumonia.Conclusions1.Serum HBP may be used to evaluate the severity of ICH with pneumonia.2.Elevated serum HBP levels are associated with poor prognosis in admission.3.Plasma HBP level can be used as an indicator to to judge whether there is infection in patients.4.Early detection of serum HBP is important for the prognosis in ICH with pneumonia.