Evaluation of Heparin-Binding Protein as a novel biomarker for the detection of periprosthetic joint infection.

Background: Heparin-Binding Protein (HBP), released during neutrophil activation and degranulation, functions in antimicrobial defense, vascular integrity regulation, and immune signal amplification. As a key effector of the innate immune system, HBP is rapidly released in response to infectious stimuli and plays a pivotal role in the pathogenesis of infectious diseases. This study aimed to evaluate the diagnostic value of HBP in periprosthetic joint infection (PJI) and compare its performance with commonly used inflammatory biomarkers. Methods: In this prospective study, 156 patients undergoing revision surgery for either aseptic loosening or PJI following joint arthroplasty were enrolled. Serum samples were collected within 24 hours preoperatively. Levels of HBP, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and procalcitonin (PCT) were measured. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of each marker, and univariate logistic regression was used to evaluate their association with PJI. Results: Serum HBP levels were significantly higher in the PJI group compared to the aseptic group (P < 0.001). The area under the ROC curve (AUC) for HBP in diagnosing PJI was 0.968 (95% CI: 0.943-0.993), outperforming CRP (0.760, 95% CI: 0.680-0.840), ESR (0.825, 95% CI: 0.753-0.896), IL-6 (0.875, 95% CI: 0.816-0.935), and PCT (0.663, 95% CI: 0.567-0.759). HBP also yielded the highest Wald χ² value (32.414) among all tested variables, with the clearest discrimination between groups in the fitted model. Conclusion: This study demonstrates that HBP is a superior diagnostic biomarker for PJI compared to traditional inflammatory indicators, offering higher sensitivity and greater cost-effectiveness. Its diagnostic advantage lies in its ability to rapidly reflect early neutrophil activation and immune initiation at the onset of infection, enabling earlier detection than conventional markers such as CRP and ESR. Given its simplicity, low cost, and strong diagnostic utility, HBP is particularly valuable for early screening of indolent infections caused by low-virulence pathogens, where traditional markers may fail.