Pediatric community-acquired pneumonia: predictive value of heparin-binding protein for severity assessment

Heparin-Binding Protein (HBP) is a promising biomarker for predicting the severity of community-acquired pneumonia (CAP). This study aimed to evaluate its role in pediatric CAP severity assessment.

A prospective observational study was conducted at the Pediatric Intensive Care Unit (PICU)and general wards of Menoufia University Hospital from February 2024 to October 2024. Thirty children with mild pneumonia (Simple Pneumonia) and 60 with severe pneumonia admitted to the PICU (Severe Pneumonia) were enrolled. Severity was assessed using WHO criteria and several clinical scores: Pediatric Respiratory Severity Score(PRESS), Respiratory Index of Severity Score (RISC), modified Predisposition, Insult, Response, and Organ dysfunction(PIROm), Pediatric Risk of Mortality(PRISM), Pediatric Index of Mortality2 (PIM2), and pediatric Sequential Organ Failure Assessment (pSOFA). Serum HBP levels were measured upon admission.

Mean HBP levels were significantly higher in severe pneumonia compared with simple pneumonia [7.87 ng/mL vs 0.73 ng/mL, p < 0.001]. All severity scores were also significantly elevated in this group and HBP was significantly correlated with these severity scores. In multivariate logistic regression, HBP was an independent predictor of pneumonia severity (adjusted odd ratio=3.23; 95%confidence interval: 1.72-6.06; p < 0.001).HBP showed excellent predictive performance, with an area under the curve (AUC) of 0.962 for severe pneumonia. A cut-off >1.2 ng/mL for HBP yielded 100% sensitivity and 90% specificity.

Serum HBP is a reliable and highly accurate biomarker for assessing CAP severity in pediatric patients and may support early clinical decision-making.

Early Risk Stratification: This study identifies Heparin-Binding Protein (HBP) as a powerful biomarker for early prediction of disease severity in pediatric community-acquired pneumonia, with an excellent diagnostic performance (AUC 0.962).

HBP demonstrated 100% sensitivity and 90% specificity at a cut-off >1.2 ng/mL, outperforming traditional clinical scores in distinguishing severe from mild cases, which can aid timely PICU admission decisions. Potential for Practice Integration: Incorporating HBP measurement into initial assessment protocols may enhance clinical decision-making, improve outcomes, and optimize resource allocation, especially in settings with high pediatric pneumonia burden. Cost and Availability of Heparin-Binding Protein: HBP levels were measured using a commercially available ELISA kit, as the test is not yet widely available in routine clinical laboratories. The assay cost ranges from approximately $400 to $800 per 96-well plate, with an estimated per-sample cost of $10-30. Due to the limited availability of clinical-grade HBP assays, testing was conducted under research conditions in a controlled laboratory setting.