Predictive Value of Heparin-Binding Protein for Organ Dysfunction and Disease Severity in Pediatric Sepsis: A...

Early risk stratification in pediatric sepsis remains difficult because conventional inflammatory markers do not fully reflect endothelial injury or microcirculatory dysfunction. This single-center retrospective observational study evaluated whether heparin-binding protein provides prognostic information for organ dysfunction and disease severity in children with sepsis admitted to the pediatric intensive care unit. A total of 150 children with sepsis admitted to the People's Hospital of Guangxi Zhuang Autonomous Region, China, were included. Heparin-binding protein and routine inflammatory markers were measured within 24 h of admission and again approximately 48 h later. Absolute and relative short-term changes in the heparin-binding protein were calculated. Outcomes included pediatric Sequential Organ Failure Assessment-defined early organ dysfunction progression, high illness severity, organ support requirements, and 28-day all-cause mortality. Prognostic performance was assessed using receiver operating characteristic analysis, multivariable logistic regression, Cox regression, calibration assessment, and reclassification metrics. Higher baseline heparin-binding protein levels and unfavorable early trajectories were associated with greater organ dysfunction, higher illness severity, and more frequent use of mechanical ventilation, vasoactive therapy, and renal replacement therapy. Heparin-binding protein demonstrated superior discriminative performance compared with conventional inflammatory biomarkers and remained independently associated with adverse outcomes after adjustment for organ dysfunction scores and routine laboratory indices. Adding heparin-binding protein metrics to models containing clinical scores and standard biomarkers improved discrimination and risk reclassification. These findings suggest that early, serial heparin-binding protein assessment may provide useful prognostic information and complement existing risk assessment frameworks for pediatric sepsis in the pediatric intensive care unit.