Early elevated HMGB1 level predicting the outcome in exertional heatstroke

Area of Science:

• Biomedical research
• Inflammation and immunity
• Critical care medicine

Background:

• Heatstroke is a critical condition characterized by hyperthermia and systemic inflammation, potentially leading to multiorgan dysfunction.
• High mobility group box-1 protein (HMGB1) is implicated as a mediator of systemic inflammation and multiorgan dysfunction.
• While HMGB1 elevation is noted in animal models of heatstroke, its role in human exertional heatstroke remains understudied.

Purpose of the Study:

• To investigate the temporal changes in plasma High mobility group box-1 protein (HMGB1) levels in patients with exertional heatstroke.
• To evaluate the prognostic value of plasma HMGB1 as a predictor of severity and mortality in exertional heatstroke.

Main Methods:

• Plasma HMGB1 levels were quantified using enzyme-linked immunosorbent assay in exertional heatstroke patients.
• C-reactive protein levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were also assessed.
• HMGB1 levels were compared between patients and healthy volunteers, and correlated with clinical severity and survival outcomes.

Main Results:

• Plasma HMGB1 levels increased early after heatstroke onset, peaking between 6-13 hours and remaining elevated for at least 6 days.
• A significant positive correlation was observed between admission HMGB1 levels and APACHE II scores (r=0.798, p<0.001).
• Admission HMGB1 levels were significantly lower in survivors compared to non-survivors (p<0.001), with a threshold of 47 ng/mL predicting lethality with 77.4% sensitivity and 84.2% specificity.

Conclusions:

• Plasma HMGB1 is a sensitive biomarker for the early stages of exertional heatstroke.
• Admission HMGB1 levels serve as a valuable indicator of illness severity and a predictor of mortality in exertional heatstroke patients.