Association Between Heparin-Binding Protein and Extubation Outcomes in ARDS: A Retrospective Cohort Study

Yinchao Zhou,1 Wei Li,2 Zhouzhou Dong1,3 1Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, 315000, People’s Republic of China; 2School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310030, People’s Republic of China; 3Health Science Center, Ningbo University, Ningbo, Zhejiang, 315211, People’s Republic of ChinaCorrespondence: Zhouzhou Dong, Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, 315000, People’s Republic of China, Tel +86 13858287868, Email [email protected]: Extubating from mechanical ventilation is crucial in acute respiratory distress syndrome (ARDS). Heparin-binding protein (HBP) has been closely linked to ARDS development. We aimed to evaluate the association between HBP trajectories and extubation outcomes in ARDS patients.Patients and Methods: This was a retrospective study of ARDS patients who were ready for extubation. Group-based trajectory modeling was applied to identify subgroups with similar HBP trajectories in this cohort. Logistic regression was used to elucidate the relationship between different trajectories and extubation success.Results: Overall, this study enrolled 267 patients from September 2023 to March 2025. Five HBP trajectories were identified including traj1 (HBP stable at extremely low level), traj2 (HBP stable at low level), traj3 (HBP descending from a high level to a low level), traj4 (HBP stable at moderate level), and traj5 (HBP stable at high level). The rates of successful extubation were 86.27%, 61.91%, 71.11%, 50.00%, and 40.98% respectively (P < 0.001). In addition, Logistic regression indicated that patients in traj2, traj3, traj4, and traj5 was associated with significantly decreased extubation success compared to those in traj1 group (odd ratio [OR] = 0.239, 95% confidence interval [CI]: 0.091– 0.630; OR = 0.195, 95% CI: 0.054– 0.706; OR = 0.143, 95% CI: 0.056– 0.368; OR = 0.081, 95% CI: 0.030– 0.220, respectively).Conclusion: In mechanically ventilated ARDS patients, distinct HBP trajectories demonstrate significant associations with extubation outcomes, suggesting their potential utility in refining extubation protocols in critical care settings.Keywords: acute respiratory syndrome, heparin-binding protein, group-based trajectory modeling, extubation outcome