Elsevier

Heart & Lung

Volume 50, Issue 6, November–December 2021, Pages 885-892
Heart & Lung

Correlation of blood high mobility group box-1 protein with mortality of patients with sepsis: A meta-analysis

https://doi.org/10.1016/j.hrtlng.2021.07.010Get rights and content

Highlights

  • Initial levels of HMGB-1 were observed to be significantly higher in septic patients who perished within 30 days, compared to those who survived.

  • Pooled results failed to demonstrate a significant association of HMGB-1 concentrations at admission with mortality of more severe sepsis, mostly septic shock.

  • A stronger correlation between blood HMGB-1 levels on day 3 after admission and fatal cases of sepsis was suggested.

  • HMGB-1 can be used for guiding sepsis management in the clinical setting.

Abstract

Background

The role of blood high mobility group box-1 (HMGB-1) protein in predicting mortality of sepsis remains controversial.

Objective

Here we conducted a meta-analysis to seek evidence for the association between blood HMGB-1 concentrations and mortality in patients with sepsis.

Methods

Eligible studies were identified by a comprehensive search of six digital databases, supplemented by a manual search of related references. Standardized mean differences (SMDs) and corresponding 95% confidence intervals (CIs) were calculated as effect estimates.

Results

A total of eighteen studies, covering 1163 patients with sepsis, were included. Compared with survival groups of sepsis, non-survival groups had significantly higher blood HMGB-1 concentrations at enrollment (SMD: 0.45, 95% CI: 0.21–0.69). Subgroup analyses showed that no significant differences were found between two groups among patients with more severe sepsis (SMD: 0.18, 95% CI: -0.02–0.38). A significant association between initial HMGB-1 levels and ≤30-day mortality remained (SMD: 0.43, 95% CI: 0.09–0.78). Besides, HMGB-1 levels were observed to be more significantly higher in non-survival groups after the third day of admission (SMD: 1.33, 95% CI: 1.05–1.62) but two groups attained comparable HMGB-1 levels on day 7 (SMD: 1.01, 95% CI: -0.31–2.33).

Conclusions

Initial high blood HMGB-1 levels are significantly associated with short-term (≤30 days) mortality of patients with sepsis, and the association may be affected by the severity of sepsis. Subsequent monitoring of HMGB-1 levels, on the third and seventh day after admission, is encouraged for better evaluation of HMGB-1 as a prognostic marker of mortality in sepsis.

Section snippets

Background

Sepsis, defined as a life-threatening organ dysfunction attributable to a dysregulated host response to infection,1 remains a major cause of death in the intensive care unit (ICU) and a critical consumer for medical resources around the world, along with its associated illnesses. According to a global study, there were an estimated 11.0 million incident cases of sepsis-related mortality worldwide in 2017, representing about 19.7% of all global deaths.2 To promptly identify sepsis patients at

Materials and methods

We conducted the study following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statements. 8

Study selection

A total of 2461 studies were yielded from six electronic databases and manual search, of which 65 potentially relevant papers were under assessment for eligibility following removing records according to titles and abstracts. After full-text evaluation, there were 18 studies finally used to meta-analyze.4,6,7,13., 14., 15., 16., 17., 18., 19., 20., 21., 22., 23., 24., 25., 26., 27. Detail regarding the process of study selection is shown in Fig. 1.

Study characteristics and quality

A total of 1163 patients with sepsis from nine

Discussion

Sepsis remains a significant, serious, and heterogeneous health problem that is difficult to be defined accurately, associated with high mortality rates worldwide. The detection and measurement of biomarkers, which are easy to handle in day-to-day clinical settings, currently have been taken as not only diagnostic tools in the face of suspected sepsis but also prognostic indicators at the diagnosis of sepsis. This meta-analysis was here to investigate the association of HMGB-1, a novel

Declaration of Competing Interest

None declared.

Acknowledgments

None declared.

Financial disclosure

None declared.

References (35)

  • JA Hayden et al.

    Assessing bias in studies of prognostic factors

    Ann Internal Med

    (19 2013)
  • JPT Higgins et al.

    Cochrane handbook for systematic reviews of interventions version 5.2.0 [updated June 2017]

    (2017)
  • D Luo et al.

    Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range

    Stat Methods Med Res

    (2018)
  • X Wan et al.

    Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

    BMC Med Res Methodol

    (2014)
  • Y Chen et al.

    [Significance of high mobility group box 1, von Willebrand factor and other cytokines in the evaluation of severity and prognosis of sepsis patients]

    Zhonghua wei zhong bing ji jiu yi xue

    (2020)
  • BX Guan et al.

    [Changes of serum HMGB1 and IGF-1 levels in sepsis patients and their relationship with T lymphocyte subsets and prognosis]

    Xian Dai Sheng Wu Yi Xue Jin Zhan

    (2020)
  • WQ Jiang et al.

    [Significance of plasma high mobility group protein -1 levels in the prognosis of patients with sepsis]

    Chin J Emerg Med

    (2011)
  • View full text