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High-mobility Group Box 1 Protein in Pediatric Trauma Patients With Acute Traumatic Coagulopathy or Disseminated
Emel Ulusoy1, Murat Duman1, Aykut Çağlar1
1Departments of Pediatric Emergency Care.
Insights
High-mobility group box 1 (HMGB1) levels increase early in pediatric trauma patients. Elevated HMGB1 is linked to acute traumatic coagulopathy (ATC), severe outcomes, and mortality.
Area of Science:
- Biochemistry
- Hematology
- Pediatric Trauma Research
Background:
- Trauma triggers High-Mobility Group Box 1 (HMGB1) release, influencing coagulation.
- HMGB1's role in trauma-induced coagulopathy requires further investigation.
Purpose of the Study:
- To assess HMGB1's utility in early diagnosis of acute traumatic coagulopathy (ATC).
- To evaluate HMGB1's association with disseminated intravascular coagulation and clinical outcomes in pediatric trauma.
Main Methods:
- Enrolled 100 pediatric trauma patients and 50 healthy controls.
- Measured HMGB1 levels using enzyme-linked immunosorbent assay (ELISA).
- Collected demographic, clinical, and laboratory data, including trauma scores and D-dimer.
Main Results:
- HMGB1 levels were significantly higher in trauma patients versus controls (P<0.001).
- Positive correlation observed between HMGB1 and D-dimer levels (r=0.589, P<0.001).
- Elevated HMGB1 associated with ATC, longer ventilation, ICU stay, hospital stay, and mortality.
Conclusions:
- Early HMGB1 elevation is characteristic of pediatric trauma.
- High HMGB1 levels are significantly associated with ATC development, severity, and adverse clinical outcomes.
Objectives:
Trauma can induce the release of high-mobility group box 1 (HMGB1), which plays an important role in the activation of coagulation. In this study, we aimed to evaluate the role of HMGB1 in the early diagnosis of acute traumatic coagulopathy (ATC), disseminated intravascular coagulation, and clinical course.
Materials And Methods:
One hundred pediatric trauma patients and 50 healthy controls were enrolled. Demographic data, physical examination results, trauma scores, International Society on Thrombosis and Hemostasis score, laboratory values, transfusion requirements, and needs for mechanical ventilation were recorded. Blood samples for HMGB1 were assessed by an enzyme-linked immunosorbent assay.
Results:
Thirty-five patients had ATC and 3 patients had overt disseminated intravascular coagulation. In trauma patients, HMGB1 levels were statistically higher than those in the control group (P<0.001). There was a positive correlation between HMGB1 levels and D-dimer levels (r=0.589, P<0.001). ATC patients had higher plasma HMGB1 levels than those without ATC (P=0.008). High HMGB1 levels were associated with the duration of mechanical ventilation, need for intensive care unit observation, length of hospital stay, and mortality.
Conclusion:
This study showed the early increase of HMGB1 in pediatric trauma cases and demonstrated the significant association of high HMGB1 levels with the development of ATC, disseminated intravascular coagulation, trauma severity, clinical outcome, and mortality.
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