Changes of serum high mobility group box 1 and soluble triggering receptor expressed on myeloid cells-1 in patients with multiple injuries and their prognostic significance

doi:10.3969/j.issn.1674-8115.2024.03.007

Abstract

Abstract:

Objective ·To detect the serum levels of high mobility group box 1 (HMGB1) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with multiple injuries at different time points, and to analyze their correlation with disease severity, complications and prognosis. Methods ·Ninety-two patients with multiple injuries admitted to the Department of Emergency Medicine of the Suzhou Ninth People′s Hospital from December 2020 to December 2022 were selected. According to the injury severity scores of the patients at admission, the patients were divided into light injury group (n=24), grave injury group (n=58) and severe injury group (n=10). According to whether there was multiple organ dysfunction syndrome (MODS) after admission, the patients were divided into MODS group (n=20) and non-MODS group (n=72). According to the outcome within 28 d after trauma, the patients were divided into death group (n=13) and survival group (n=79). Inflammatory factor indicators in venous blood of patients after admission were detected. Enzyme linked immunosorbent assay (ELISA) was used to detect the serum HMGB1 and sTREM-1 levels at 24 h, 72 h and 7 d after trauma, and the differences of serum HMGB1 and sTREM-1 levels among different groups were analyzed. Multiple Logistic regression was used to analyze the influencing factors of adverse outcomes in patients with multiple injuries. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of HMGB1 and sTREM-1 for adverse outcomes. Results ·The levels of HMGB1 and sTREM-1 in the grave injury and severe injury groups were significantly higher than those in the light injury group (P<0.05). The levels of HMGB1 at 72 h and 7 d, and sTREM-1 at 24 h and 72 h in the severe injury group were significantly higher than those in the grave injury group (P<0.05). There was a positive correlation between HMGB1 and sTREM-1 levels at various time points (r=0.645, r=0.942, r=0.722; all P<0.05). The levels of HMGB1 at 72 h and 7 d, and sTREM-1 at 24 h and 72 h in the MODS group were significantly higher than those in the non-MODS group (all P<0.05). The levels of HMGB1 at 72 h and 7 d, and sTREM-1 at 24 h and 72 h in the death group were significantly higher than those in the survival group (all P<0.05). Logistic regression analysis showed that HMGB1 at 7 d, admission time and hypersensitive C-reactive protein (hs-CRP) were independent factors of adverse outcomes in patients with multiple injuries (all P<0.05). The ROC curve showed that the area under the curve of HMGB1 for predicting poor prognosis at 7 days after trauma was 0.890, the sensitivity was 83.5%, and the specificity was 92.3%. Conclusion ·The levels of HMGB1 and sTREM-1 are correlated with MODS and survival outcomes in patients with multiple injuries at different time points after trauma, and HMGB1 at 7 d after trauma is an independent factor affecting adverse outcomes in patients with multiple injuries.

Key words: multiple injury, high mobility group box 1 (HMGB1), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), prognosis

CLC Number:

R459.7

WANG Guijie, DU Chuanchong, LU Ye, ZHAO Jian, SHEN Xie, JIN Donglin, GENG Jiacai. Changes of serum high mobility group box 1 and soluble triggering receptor expressed on myeloid cells-1 in patients with multiple injuries and their prognostic significance[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(3): 350-357.

Figures/Tables 7

TrendMD

References 28

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Variable	Light injury group (n=24)	Grave injury group (n=58)	Severe injury group (n=10)	P value^③	P value^④	P value^⑤
HMGB1/(ng·mL^-1)^①
24 h	2.47±0.61	2.86±0.65	2.99±0.52	0.013	0.030	0.531
72 h	3.12±0.73	3.57±0.66	4.22±0.31	0.006	0.000	0.005
7 d	3.63±0.83	4.19±0.77	4.96±0.35	0.003	0.000	0.004
sTREM-1/(ng·mL^-1)^②
24 h	11.71±3.00	13.43±2.65	15.38±1.95	0.010	0.000	0.037
72 h	12.77±3.47	14.46±2.74	16.51±1.99	0.017	0.001	0.041
7 d	5.52±1.24	6.47±1.25	6.72±1.20	0.006	0.015	0.463

Variable	Light injury group (n=24)	Grave injury group (n=58)	Severe injury group (n=10)	P value^③	P value^④	P value^⑤
HMGB1/(ng·mL^-1)^①
24 h	2.47±0.61	2.86±0.65	2.99±0.52	0.013	0.030	0.531
72 h	3.12±0.73	3.57±0.66	4.22±0.31	0.006	0.000	0.005
7 d	3.63±0.83	4.19±0.77	4.96±0.35	0.003	0.000	0.004
sTREM-1/(ng·mL^-1)^②
24 h	11.71±3.00	13.43±2.65	15.38±1.95	0.010	0.000	0.037
72 h	12.77±3.47	14.46±2.74	16.51±1.99	0.017	0.001	0.041
7 d	5.52±1.24	6.47±1.25	6.72±1.20	0.006	0.015	0.463

Variable	Non-MODS group (n=72)	MODS group (n=20)	P value
HMGB1/(ng·mL^-1)^①
24 h	2.71±0.65	2.99±0.60	0.086
72 h	3.42±0.70	3.88±0.66	0.011
7 d	4.01±0.82	4.57±0.76	0.008
sTREM-1/(ng·mL^-1)^②
24 h	12.83±2.77	14.50±2.87	0.020
72 h	13.84±2.96	15.71±2.97	0.014
7 d	6.07±1.20	6.69±1.71	0.069

Variable	Non-MODS group (n=72)	MODS group (n=20)	P value
HMGB1/(ng·mL^-1)^①
24 h	2.71±0.65	2.99±0.60	0.086
72 h	3.42±0.70	3.88±0.66	0.011
7 d	4.01±0.82	4.57±0.76	0.008
sTREM-1/(ng·mL^-1)^②
24 h	12.83±2.77	14.50±2.87	0.020
72 h	13.84±2.96	15.71±2.97	0.014
7 d	6.07±1.20	6.69±1.71	0.069

Variable	Survival group (n=79)	Death group (n=13)	t/χ² value	P value
Age/year	42.53±11.64	47.31±11.71	1.369	0.174
Gender/n(%)			0.837	0.546
Male	44 (55.70)	9 (69.23)
Female	35 (40.30)	4 (30.77)
Background disease/n(%)			0.387	0.747
Yes	25 (31.65)	3 (23.08)
No	54 (68.35)	10 (76.92)
Admission time/h	4.43±0.92	5.00±0.51	3.259	0.003
Injury factor/n(%)			1.224	0.570
Transportation	54 (68.35)	8 (61.54)
Fall accident from high place	19 (24.05)	3 (23.08)
Other	6 (7.59)	2 (15.38)
Number of wound sites/n	2.66±0.64	2.92±0.49	1.425	0.158
Primary trauma site/n(%)			7.400	0.042
Head	32 (40.51)	11 (84.62)
Chest	27 (34.18)	1 (7.69)
Abdomen	14 (17.72)	1 (7.69)
Limbs and pelvis	6 (7.59)	0 (0)
Emergency operation/n(%)			2.391	0.181
Yes	20 (25.32)	6 (46.15)
No	59 (74.68)	7 (53.85)
Massive transfusion/n(%)			4.778	0.055
Yes	24 (34.18)	8 (61.54)
No	55 (65.82)	5 (38.46)
Severity/n(%)			19.475	0.000
Lightly injury	22 (27.85)	2 (15.38)
Gravely injury	54 (68.35)	4 (30.77)
Severe injury	3 (3.80)	7 (53.85)
GCS score/score	10.31±2.04	9.51±2.27	1.286	0.202
APTT/s	30.31±5.02	32.97±5.91	1.727	0.088
DD/(mg·L^-1)	0.81±0.37	0.89±0.29	0.770	0.443
MODS/n(%)			5.304	0.032
Yes	14 (17.72)	6 (46.15)
No	65 (82.28)	7 (53.85)
hs-CRP/(mg·L^-1)	18.74±3.98	21.79±3.28	2.612	0.011
IL-6/(pg·mL^-1)	65.16±14.11	78.33±10.46	3.215	0.002
PCT/(ng·mL^-1)	4.06±0.90	5.02±0.91	3.560	0.001