Clinical Value Of Heparin-binding Protein In Sputum In Pulmonary Infection

Objective: Pulmonary infection refers to the inflammation of lung parenchyma including terminal airway,alveolar cavity and lung interstitium,which most common cause is infection.At present,lower respiratory tract infections(LRTIs)were the fourth leading cause of death.Despite all new medical tools and methods,pneumonia is difficult to diagnose clinically,resulting from the lack of a “gold standard” method of diagnosis.The purpose of this study was to explore the value of sputum heparin binding protein(S-HBP)in the diagnosis of pulmonary infection,and compared with procalcitonin(PCT),white blood cell count(WBC),C-reactive protein(CRP),plasma heparin binding protein(P-HBP).In order to provide a reference for the diagnosis of pulmonary infection and rational use of antibiotics.Method:From September 2020 to January 2021,108 patients with suspected pulmonary infection in the Third Hospital of Hebei Medical University and their sputum samples induced by hypertonic saline,medical records and blood samples were collected.According to diagnostic criteria in the consensus meeting of the American College of Chest Physicians and the Society for Critical Care Medicine.The results were statistically analyzed.The receiver operator characteristic curve(ROC curve)was established,calculated the area under the ROC curve,found the optimal cut-off value,and compare the PCT,the WBC,CRP,P-HBP,S-HBP for diagnosed pulmonary infection such as specificity,sensitivity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio and accuracy.CRP,P-HBP and S-HBP were analyzed in the pulmonary infection group according to CURB-65 score.Result:1.The levels of CRP,P-HBP and S-HBP between the pulmonary infection group and the non-pulmonary infection group are statistically significant(P<0.05),but there is no statistical difference in PCT and WBC(P>0.05).2.The area under the ROC curve of CRP,P-HBP and S-HBP are 0.66,0.756 and 0.813 respectively for the diagnosis of pulmonary infection.When the Cup-off value of S-HBP is 1061.78ng/m L,the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy of P-HBP in the diagnosis of pulmonary infection are 83%,73.5%,77.2%,80%,3.13,0.36,and 78.4%.3.There is correlation between CRP and S-HBP,and between P-HBP and S-HBP,which correlation coefficients of 0.25 and 0.487,respectively.4.Gram-negative bacteria accounted for 80% of the pathogenic bacteria of lung infection,and the dominant bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae subspecies,Acinetobacter baumannii,Stenotrophomonas maltophilia,accounting for 23.8%,18.7%,15%,8.8%,6.2%,respectively.There were 8 strains of Gram-positive bacteria,accounting for 10%,mainly Enterococcus,Staphylococcus aureus and Streptococcus pneumoniae,accounting for 2.5%,3.8% and 3.8%,respectively.There were 8strains of pathogenic fungi for pulmonary infection,accounting for 10%,with Aspergillus and Candida albicans as the main strains,accounting for 7.5% and2.5%,respectively.5.P-HBP was statistically different between the medium-risk group and the high-risk group,and between the low-risk group and the high-risk group.CRP,S-HBP and P-HBP were all statistically significant in the comparison between the low-risk group and the high-risk group,but CRP and P-HBP were not statistically significant in the low-risk group and the medium-risk group.Conclusion:1.Gram-negative bacteria were the main pathogens of pulmonary infection,among which the main pathogens were Pseudomonas aeruginosa,Klebsiella pneumoniae subspecies,Acinetobacter baumannii,Stenotrophomonas maltophilia.2.CRP,P-HBP and S-HBP are all valuable in the diagnosis of pulmonary infection.3.HBP in sputum has good sensitivity and specificity in the diagnosis of pulmonary infection.Under the condition of normal white blood cell count and PCT,high HBP has been found in pulmonary infected sputum,which is expected to become a biomarker for pulmonary infection.4.There is no difference in PCT between the pulmonary infection group and the non-pulmonary infection group,so whether PCT is a diagnosis of pulmonary infection should be further verified.5.S-HBP is dozens or hundreds of times more than P-HBP,and the P-HBP and S-HBP in the high-risk group were significantly higher than those in the low-risk group,which suggest that HBP is related to the location and severity of infection.