HMGB1 as a predictor of organ dysfunction and outcome in patients with severe sepsis
HMGB1 as a predictor of organ dysfunction and outcome in patients with severe sepsis
复制标题
DOI：
10.1007/s00134-008-1032-9
复制
发表时间：
2008-06-01
影响因子：
38.9
通讯作者：
Ruokonen, Esko
中科院分区：
文献类型：
--
作者：
Karlsson, Sari;Pettila, Ville;Ruokonen, Esko
目的：探讨高迁移率族蛋白B1（HMGB 1）对严重脓毒症患者住院病死率的预测价值。研究设计：芬兰24个ICU的前瞻性观察性队列研究。患者：247例严重脓毒症成人患者。测量和主要结果：从基线时的247名患者和72小时后的210名患者中抽取血液样本进行HMGB 1分析。平均APACHE II和SAPS II评分分别为24（SD 9）和44（SD 17）。住院死亡率为26%。首先通过半定量Western免疫印迹（WB）分析测定血清HMGB 1浓度。第0天的中位HMGB 1浓度为108%（IQR 98.5-119），72 h后为107%（IQR 98.8-120），与健康对照组不同（分别为97.5%，IQR 91.3-106.5; p = 0.028和0.019）。通过ELISA（在170名患者的亚组中）对样本进行再分析，以通过WB确认结果。健康对照的中位浓度为0.65 ng/ml（IQR 0.51-1.0）。这低于严重脓毒症患者（3.6 ng/ml，IQR 1.9-6.5，p < 0.001）。HMGB 1浓度（WB和ELISA）在医院幸存者和非幸存者之间没有差异。在ROC分析中，第0天和第72 h的HMGB 1水平（WB）与住院死亡率相关，曲线下面积分别为0.51和0.56（95%CI 0.40-0.61和0.47-0.65）。结论：血清HMGB 1浓度在严重脓毒症患者中升高，但在幸存者和非幸存者之间没有差异，并且不能预测住院死亡率。
Objective: To study the predictive value of high mobility group box-1 protein ( HMGB1) and hospital mortality in adult patients with severe sepsis. Study design: Prospective observational cohort study in 24 ICUs in Finland. Patients: Two hundred and forty-seven adult patients with severe sepsis. Measurements and main results: Blood samples for HMGB1 analyses were drawn from 247 patients at baseline and from 210 patients 72 h later. The mean APACHE II and SAPS II scores were 24 ( SD 9) and 44 ( SD 17), respectively. The hospital mortality was 26%. The serum HMGB1 concentrations were measured first by semi-quantitative Western immunoblotting ( WB) analysis. The median HMGB1 concentration on day 0 was 108% ( IQR 98.5-119) and after 72 h 107% ( IQR 98.8-120), which differed from healthy controls ( 97.5%, IQR 91.3-106.5; p = 0.028 and 0.019, respectively). The samples were reanalysed by ELISA ( in a subgroup of 170 patients) to confirm the results by WB. The median concentration in healthy controls was 0.65 ng/ml ( IQR 0.51-1.0). This was lower than in patients with severe sepsis ( 3.6 ng/ml, IQR 1.9-6.5, p < 0.001). HMGB1 concentrations ( WB and ELISA) did not differ between hospital survivors and non-survivors. In ROC analyses for HMGB1 levels ( WB) on day 0 and 72 h with respect to hospital mortality, the areas under the curve were 0.51 and 0.56 ( 95% CI 0.40-0.61 and 0.47-0.65). Conclusions: Serum HMGB1 concentrations were elevated in patients with severe sepsis, but did not differ between survivors and non-survivors and did not predict hospital mortality.