Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcomes in patients with postoperative myocardial injury-related cardiogenic shock (MIRCS). We aimed to evaluate and validate HBP as a prognostic biomarker for postoperative MIRCS. We performed a case-control study in 792 patients undergoing cardiac surgery from January 1, 2016, to August 1, 2019, including 172 patients with postoperative MIRCS and 620 age- and sex-matched controls. The association between HBP and MIRCS was determined by multivariate logistic regression analysis. Receiver operating characteristic curves (ROCs) with area under the curve (AUC) were performed to calculate the cut-off value, sensitivity and specificity. The association between HBP and cardiac troponin T (cTnT) was determined by multivariable linear regression analysis. Blood samples were drawn from the coronary sinus and arterial line of the cardiopulmonary bypass (CPB) before aortic cross-clamping (time point 1) and 5 min after aortic declamping (time point 2). Before aortic cross-clamping, coronary sinus HBP (HBPCS1) showed no differences between the two groups. However, after declamping, the MIRCS group had a significantly higher sinus HBP level (HBPCS2) than did the control group. HBPCS2 predicted MIRCS with an AUC of 0.85 (95% CI: 0.81–0.89, cut-off: 220 ng/ml, sensitivity: 92% and specificity: 70%). After adjusting for confounding factors, we found that HBP was an independent risk factor for MIRCS (OR: 7.65, 95% CI: 4.86–12.06, P < 0.01) and was positively associated with cTnT (β > 0, P < 0.01). Elevated levels of coronary sinus HBP were useful biomarkers for predicting MIRCS after cardiac surgery.

中文翻译：

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肝素结合蛋白测量可改善心肌损伤相关心源性休克的预测

肝素结合蛋白（HBP）是增强血管通透性的有效诱导剂，是预测术后心肌损伤相关性心源性休克（MIRCS）患者预后的潜在有用生物标志物。我们旨在评估和验证HBP作为术后MIRCS的预后生物标志物。我们对2016年1月1日至2019年8月1日进行心脏手术的792例患者进行了病例对照研究，其中包括172例术后MIRCS患者和620个年龄和性别匹配的对照。通过多因素logistic回归分析确定HBP和MIRCS之间的关联。进行接收器工作特征曲线（ROC）及其在曲线下的面积（AUC），以计算截断值，灵敏度和特异性。通过多变量线性回归分析确定HBP和心肌肌钙蛋白T（cTnT）之间的关联。在主动脉钳夹前（时间点1）和主动脉钳夹后5分钟（时间点2）从体外循环（CPB）的冠状窦和动脉血中抽取血样。在主动脉夹钳之前，两组的冠状窦HBP（HBPCS1）没有差异。然而，放松后，MIRCS组的鼻窦HBP水平（HBPCS2）明显高于对照组。HBPCS2预测的MIRCS的AUC为0.85（95％CI：0.81-0.89，临界值：220 ng / ml，敏感性：92％，特异性：70％）。调整混杂因素后，我们发现HBP是MIRCS的独立危险因素（OR：7.65，95％CI：4.86-12.06，P <0.01），与cTnT正相关（β> 0，P <0.01）。冠状窦HBP水平升高是预测心脏手术后MIRCS的有用生物标志物。