Prospective Multi-centre Clinical Study to Assess the Clinical Validity of the Heparin Binding Protein Assay to Indicate the Presence and Outcome of Sepsis in Patients With Suspected Infection Following Emergency Department Admission

The purpose of this prospective, non-interventional, multi-centre clinical study is to assess the clinical validity of the Heparin Binding Protein (HBP) assay for indicating the presence, or outcome, of severe sepsis (including septic shock), over 72 hours, in patients with suspected infection following emergency department admission.

Sepsis is an increasingly common cause of morbidity and mortality, with approximately 150,000 people in Europe and 215,000 people in the US dying of severe sepsis each year. Deaths attributable to sepsis continue to rise due to an increase in incidence of the disease, which can be attributed to numerous factors including the aging population, the increased number of immuno-compromised patients, the increased use of invasive surgery and the increased incidence of microbial resistance.

The sepsis syndrome was first described in the 1992 publication by Bone et al detailing the conclusions of the ACCP/SCCM Consensus Conference held in 1991, which first introduced the Systemic Inflammatory Response Syndrome (SIRS) classification system. Systemic Inflammatory Response Syndrome (SIRS) is considered to be present when patients have 2 or more of the following clinical findings:

• body temperature, >38ºC or <36ºC
• heart rate, >90 beats per minute
• respiratory rate of >20 breaths per minute or a PaCO2 of <32mm Hg
• white cell count of >12,000 cells per µL or <4,000 per µL, or >10% immature (band) forms According to the suggested definitions, sepsis is defined as SIRS plus confirmed infection, severe sepsis is defined as sepsis associated with organ dysfunction, hypoperfusion, or hypotension and septic shock is defined as sepsis-induced hypotension, persisting despite adequate fluid resuscitation.

Diagnosis of sepsis traditionally relies on identification of the above symptoms, as well as culturing techniques to confirm and identify the infection. This method of diagnosis is, however, far from ideal as it has been demonstrated that SIRS criteria are poorly predictive of subsequent events in the sepsis cascade and that approximately one half of severe sepsis cases are culture negative. In addition, the assay time for culture-based diagnosis is 24 to 48 hours, where it has been shown that diagnosis of severe sepsis and septic shock as early as possible is important, as each hour of delay in effective antimicrobial administration is associated with an average decrease in survival of 7.6%. Although the majority of severe sepsis patients receive treatment in an intensive care unit (ICU), it is estimated that up to two thirds of those patients initially present to the emergency department (ED), and that approximately 20% of patients with confirmed infection who present to the ED with uncomplicated sepsis progress to severe sepsis or septic shock within 72 hours.