Association of High Mobility Group Box 1 Protein Levels with Sepsis and Outcomes in Newborns

Öz

High mobility group box-1 protein (HMGB-1) acts as a potent pro-inflammatory cytokine that is actively secreted by innate immune cells and/or passively released by injured or damaged cells during the terminal phase of sepsis. Therefore, serum and tissue levels of HMGB1 are elevated during infection, especially during sepsis. In this study, we aimed to evaluate HMGB1 levels in neonatal sepsis and its association with septic shock and death. Fifty-three neonates with a clinical or proven diagnosis of sepsis were included in the study. Fifty-seven postnatal age-matched neonates without symptoms or signs of infection and receiving routine NICU care were included as controls. Twelve patients had proven sepsis and 6 patients had septic shock. The death occurred in five septic infants. HMGB1 levels were higher in neonates with sepsis compared with controls; patients with septic shock had higher HMGB1 levels compared with those without septic shock (p=0.002). Although non-survivors had higher HMGB1 levels compared to survivors, this was not statistically significant (p=0.086). HMGB1 levels decreased significantly three days after diagnosis in patients without septic shock (p=0.014) but remained elevated in patients with septic shock (p=0.465). A positive correlation was found between CRP and HMGB1 (p=0.008, r=0.252). HMGB1 is a sensitive marker for differentiating patients with sepsis from the non-septic group. The addition of HMGB1 to the group of inflammatory markers may be useful in the detection of patients with severe sepsis compared to the diagnosis of sepsis.

Anahtar Kelimeler

• biomarker
• high mobility group box 1 protein
• newborn
• neonatal sepsis
• septic shock

Yenı̇Doğanlarda High Mobility Group Box 1 Protein Düzeylerı̇nin Sepsı̇s ve Sonuçlarıyla İlişkisi

Öz

High mobility group box-1 protein (HMGB-1); sepsisin son fazında doğal bağışıklık hücreleri tarafından aktif olarak salgılanan ve/veya yaralı veya hasarlı hücreler tarafından pasif olarak salınan güçlü bir pro-inflamatuar sitokin olarak görev yapar. Bu nedenle, HMGB1'in serum ve doku seviyeleri enfeksiyon sırasında, özellikle sepsis sırasında yükselir. Bu çalışmada, yenidoğan sepsisinde HMGB1 seviyelerini ve septik şok ve ölümle ilişkisinin değerlendirilmesi amaçlandı. Klinik veya kanıtlanmış sepsis tanısı olan 53 yenidoğan çalışmaya dahil edildi. Enfeksiyon semptomu veya bulgusu olmayan ve rutin YYBÜ bakımı alan doğum sonrası yaşı eşleştirilmiş elli yedi yenidoğan kontrol olarak alındı. On iki hastada kanıtlanmış sepsis, 6 hastada septik şok vardı. Beş septik bebek kaybedildi. Sepsisli yenidoğanlarda HMGB1 düzeyleri kontrollere kıyasla daha yüksekti; septik şoklu hastalarda septik şok olmayanlara kıyasla daha yüksek HMGB1 düzeyleri vardı (p=0,002). Hayatta kalmayanların hayatta kalanlara kıyasla daha yüksek HMGB1 seviyelerine sahip olmasına rağmen, bu istatistiksel olarak anlamlı değildi (p=0,086). HMGB1 düzeyleri septik şoku olmayan hastalarda tanıdan üç gün sonra önemli ölçüde düşerken (p=0,014) septik şok gelişen hastalarda yüksek kaldı (p=0,465). CRP ile HMGB1 arasında pozitif bir korelasyon saptandı (p=0,008, r=0,252). HMGB1, sepsisli hastaları septik olmayan gruptan ayırmak için hassas bir belirteçtir. Enflamatuar belirteçler grubuna HMGB1'in eklenmesi, sepsis tanısına kıyasla ciddi sepsisli hastaların tespitinde faydalı olabilir.

Anahtar Kelimeler

• biyobelirteç
• High mobility group box 1 protein
• yenidoğan
• neonatal sepsis
• septik şok

Kaynakça

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