Association between trajectory of heparin-binding protein and extubation | IJGM
Introduction
Acute respiratory distress syndrome (ARDS) is a critical condition characterized by severe hypoxemia and bilateral chest radiographical opacities due to non-cardiogenic pulmonary edema. It is a life-threatening illness with high mortality rates, making accurate prediction of extubation success crucial. The pathophysiology of ARDS involves injury to pulmonary vascular endothelial cells and alveolar epithelia, leading to increased capillary permeability and fluid leakage, which impairs pulmonary function. Therefore, evaluating the dynamics of pulmonary vascular permeability before extubation is essential for ARDS management.
Heparin-binding protein (HBP), a neutrophil-derived granular protein, plays a pivotal role in ARDS by mediating proinflammatory cytokine release, immune cell chemotaxis, and endothelial damage. Clinical investigations have validated that ARDS patients exhibit significantly elevated HBP levels, strongly correlating with the development and severity of the disorder. However, research on the relationship between HBP dynamics and extubation outcomes in ARDS patients remains limited.
Methodology
This study conducted longitudinal HBP monitoring and leveraged group-based trajectory modeling (GBTM) to investigate associations between different HBP trajectories and extubation outcomes in ARDS patients. The findings aim to establish a predictive tool to guide ventilator weaning strategies and optimize clinical decision-making.
ARDS patients admitted to the ICU of Ningbo Medical Center Lihuli Hospital between September 2023 and March 2025 were enrolled. The diagnosis of ARDS was established according to the new global criteria. HBP levels were measured daily from 1 to 6 days after enrollment. The primary outcome was extubation success, defined as sustained spontaneous breathing for more than 48 hours following extubation without mechanical ventilation. Trajectories of HBP were categorized using GBTM, and logistic regression analysis was conducted to identify factors associated with extubation success.
Results
Five distinct HBP trajectories were identified: traj1 (persistently extremely low HBP), traj2 (persistently low HBP), traj3 (high-to-low transitional HBP), traj4 (persistently moderate HBP), and traj5 (persistently high HBP). The extubation success rate progressively decreased from traj1 to traj5, with statistically significant differences observed between groups. Subgroup analysis by age and SOFA score revealed robust associations between distinct HBP trajectories and extubation outcomes in patients aged ≥ 72 years and with SOFA scores < 7 or ≥ 7.
Discussion
This study identified distinct HBP trajectories associated with extubation success in ARDS patients. Patients with higher HBP levels were at a higher risk of extubation failure. These findings may assist clinicians in identifying high-risk populations and provide clinical guidelines for extubation decision-making. However, further research is needed to establish specific HBP cut-off values and validate these trajectories prospectively.
Conclusion
In conclusion, monitoring HBP dynamics could help clinicians identify patients at high risk for extubation failure, who may benefit from more vigilant monitoring and tailored weaning protocols. Future research should focus on validating these trajectories and establishing specific HBP cut-off values to guide clinical decision-making.
