Prognostic role of serum high mobility group box 1 concentration in cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Inflammation Biology
• Biomarker Discovery

Background:

• Systemic inflammation significantly impacts cardiac surgery outcomes.
• High mobility group box 1 (HMGB1) is a key inflammatory mediator implicated in cardiovascular disease.
• HMGB1's prognostic value as a biomarker in cardiac surgery requires further investigation.

Purpose of the Study:

• To prospectively examine the association between serum HMGB1 concentrations and composite morbidity endpoints in patients undergoing cardiac surgery.
• To determine if HMGB1 levels can serve as a predictive biomarker for adverse outcomes post-cardiac surgery.

Main Methods:

• Prospective, observational study involving 250 cardiac surgery patients.
• Serum HMGB1 levels measured at baseline (after anesthetic induction) and post-cardiopulmonary bypass (post-CPB).
• Composite morbidity endpoints included death, myocardial infarction, stroke, renal failure, and prolonged ventilation.

Main Results:

• Post-CPB HMGB1 concentrations, but not baseline levels, showed a significant association with the incidence of composite morbidity endpoints (p=0.005).
• Multivariable analysis identified post-CPB HMGB1 concentration (OR=1.072, p=0.044), pre-operative creatinine, and CPB duration as independent risk factors for adverse outcomes.
• Higher post-CPB HMGB1 levels correlated with increased risk of morbidity.

Conclusions:

• Serum HMGB1 measured 1 hour after weaning from CPB is a valuable biomarker for risk stratification in cardiac surgery patients.
• HMGB1's role in sterile inflammation and its association with adverse outcomes suggest potential for guiding targeted anti-inflammatory therapies.
• Post-CPB HMGB1 levels offer a reliable indicator of patient prognosis following cardiac surgery.