Is HSP-27 an emerging marker of good prognosis in septic shock patients? A pilot study

Introduction:
Many biomarkers are used to assess the severity of sepsis and septic shock (SS), but none are highly sensitive in predicting outcome. Aim of the research: To estimate the value of serum changes of C-reactive protein, procalcitonin, presepsin, heat shock protein 27 (HSP27) and neutrophil to lymphocyte ratio in assessing the prognosis in patients with SS treated in an intensive care unit.

Material and methods:
Thirty-seven selected adult patients with SS were included. Serum concentrations of biomarkers were measured at admission and daily for 4 consecutive days (time points T0,T1, T2, T3 and T4 respectively). The mortality rate was determined 28 days after admission. Patients were divided into survivor and non-survivor groups according to their mortality. The differences between the levels of biomarkers at the time points T0 and T4 were analyzed.

Results:
The mean value of the SOFA score on admission was 11.7 ±2.7, and the APACHE II scale 29.9 ±6.85. Nine patients died. Univariate logistic analysis revealed that changes between T0 and T4 of presepsin, procalcitonin, and HSP27 were associated with prognosis. A multivariate Cox analysis showed that an increase in HSP27 at T4 was the only independent predictor of good prognosis in SS patients. The area under the receiver operating characteristics curve for HSP27 was 0.785. Kaplan-Meier analysis showed that the mortality was lower (p = 0.014) in patients who had an increase in HSP27 at T4 compared to those whose serum HSP27 did not increase at T4.

Conclusions:
The increase of HSP27 level on the 4^th day predicts a favorable outcome in SS patients.