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BMC Anesthesiol
. 2026 Jun 23;26(1):379.
doi: 10.1186/s12871-026-04050-0.
Heparin-binding protein and Endothelin-1 in critical COVID-19
Halla Halldorsdottir 1 2 , Jesper Eriksson 3 4 , Olav Rooyackers 5 4 , Jonathan Grip 5 4 , Johan Mårtensson 3 4 , Eddie Weitzberg # 3 4 , Anders Oldner # 3 4
Affiliations
Background: Heparin-binding protein (HBP) is an inflammatory protein released by activated polymorphonuclear white cells. It has been suggested as a predictor of sepsis progression and organ dysfunction and plays a role in the pathophysiology of endothelial dysfunction. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor with pro-inflammatory effects, and high levels are found in patients with sepsis and acute respiratory distress syndrome. We investigated HBP and ET-1 plasma levels in critical COVID-19 disease with the aim of evaluating whether they were associated with 60-day mortality or the need for invasive mechanical ventilation (IMV). These levels were compared with those of a cohort of post-trauma intensive care unit (ICU) patients.
Methods: We included 96 patients with critical COVID-19 disease in 2020 and ten post-trauma ICU patients. Blood samples were collected at ICU admission, and plasma levels of HBP and ET-1 were measured. Clinical and laboratory data were collected until ICU discharge or death.
Results: In COVID-19 patients, plasma levels of HBP were markedly increased, with a median level of 150 ng/ml (IQR 47-299), compared to 13.3 ng/ml (IQR 8.8-62.1), p < 0.0001 in the trauma ICU patients. There was no association between HBP levels and 60-day mortality or need for IMV. The levels of ET-1 were 1.6 pg/ml (IQR 1.2-1.9) in the COVID-19 cohort and 2.0 pg/ml (IQR 1.2-2.8), p = 0.25 in the trauma ICU cohort. COVID-19 patients requiring IMV hade higher ET-1 levels than those who did not require such treatment; however, no association was found in a logistic regression model when adjusted for age, sex and body mass index. There was no correlation between plasma HBP and ET-1 levels. Inflammatory parameters such as C-reactive protein, procalcitonin, ferritin, and interleukin-6, were elevated but did not distinguish survivors from non-survivors.
Conclusion: While HBP levels are markedly elevated in critical COVID-19, they do not predict outcomes at ICU admission. ET-1 levels were also not linked to mortality or the need for IMV.
Keywords: COVID-19; Endothelin-1; Heparin-binding protein; Intensive care unit; Invasive mechanical ventilation; Mortality.
. 2026 Jun 23;26(1):379.
doi: 10.1186/s12871-026-04050-0.
Heparin-binding protein and Endothelin-1 in critical COVID-19
Halla Halldorsdottir 1 2 , Jesper Eriksson 3 4 , Olav Rooyackers 5 4 , Jonathan Grip 5 4 , Johan Mårtensson 3 4 , Eddie Weitzberg # 3 4 , Anders Oldner # 3 4
Affiliations
- PMID: 42337728
- DOI: 10.1186/s12871-026-04050-0
Background: Heparin-binding protein (HBP) is an inflammatory protein released by activated polymorphonuclear white cells. It has been suggested as a predictor of sepsis progression and organ dysfunction and plays a role in the pathophysiology of endothelial dysfunction. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor with pro-inflammatory effects, and high levels are found in patients with sepsis and acute respiratory distress syndrome. We investigated HBP and ET-1 plasma levels in critical COVID-19 disease with the aim of evaluating whether they were associated with 60-day mortality or the need for invasive mechanical ventilation (IMV). These levels were compared with those of a cohort of post-trauma intensive care unit (ICU) patients.
Methods: We included 96 patients with critical COVID-19 disease in 2020 and ten post-trauma ICU patients. Blood samples were collected at ICU admission, and plasma levels of HBP and ET-1 were measured. Clinical and laboratory data were collected until ICU discharge or death.
Results: In COVID-19 patients, plasma levels of HBP were markedly increased, with a median level of 150 ng/ml (IQR 47-299), compared to 13.3 ng/ml (IQR 8.8-62.1), p < 0.0001 in the trauma ICU patients. There was no association between HBP levels and 60-day mortality or need for IMV. The levels of ET-1 were 1.6 pg/ml (IQR 1.2-1.9) in the COVID-19 cohort and 2.0 pg/ml (IQR 1.2-2.8), p = 0.25 in the trauma ICU cohort. COVID-19 patients requiring IMV hade higher ET-1 levels than those who did not require such treatment; however, no association was found in a logistic regression model when adjusted for age, sex and body mass index. There was no correlation between plasma HBP and ET-1 levels. Inflammatory parameters such as C-reactive protein, procalcitonin, ferritin, and interleukin-6, were elevated but did not distinguish survivors from non-survivors.
Conclusion: While HBP levels are markedly elevated in critical COVID-19, they do not predict outcomes at ICU admission. ET-1 levels were also not linked to mortality or the need for IMV.
Keywords: COVID-19; Endothelin-1; Heparin-binding protein; Intensive care unit; Invasive mechanical ventilation; Mortality.