Objective: The aim of this study was to investigate possible associations between
Heparin-binding protein (HBP) and the development of
respiratory failure (RF) and
sepsis in
critically ill children with severe community-acquired
pneumonia (CAP). Methods: This study enrolled 157 children with severe CAP admitted to Intensive Care Unit (ICU). At ICU admission, the levels of HBP and other
biomarkers, including
C-reactive protein,
interleukin-6 (IL-6),
procalcitonin, white blood cells, neutrophil percentage, and
D-dimer, were determined. Results: Of the enrolled patients, 106 developed RF (35 with RF at enrollment and 71 with RF after enrollment), while 51 did not developed RF. The number of patients progressing to
sepsis in those with or without RF were 34 (21 with
severe sepsis) and 14, respectively. The plasma level of HBP at admission was more than eightfold higher than the upper normal value. HBP,
IL-6, and
D-dimer could significantly predict the development of RF, and a high level of HBP (odds ratio = 1.008, 95% confidence interval: 1.003-1.013) was independently associated with the development of RF in this population. Compared with other
biomarkers, HBP was the best
indicator of progression to
severe sepsis, with an area under the receiver operating characteristic curve of 0.85, the best specificity at 96.30%, and a positive predictive value of 92.86% at the optimal cut-off value of 340.29 ng/mL. The HBP level was also positively correlated with other conventional
biomarkers. Conclusion: HBP might represent a better predictor of
disease progression in children with severe CAP than currently used
biomarkers.