Serum Level of High-mobility Group Box Protein-1 in Children with Sepsis, Severe Sepsis and Septic Shock

Introduction: Sepsis is an important risk factor for morbidity and mortality in children. Early recognition of sepsis as the most important step in reducing morbidity and mortality. Due to the limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), new research is needed to identify sepsis biomarkers. High mobility group box protein-1 (HMGB1) is one of the late mediators of sepsis. Comparing serum HMGB1 levels between healthy children and those with sepsis is the main goal of our research. Methods: This prospective multicenter clinical trial. We prospectively collected 43 cases of sepsis treated (3 months to 17 years old) in two different pediatric intensive care units between January 1 and June 30, 2017. The sepsis group was subdivided into sepsis, severe sepsis, and septic shock. The patient and healthy control groups were compared (n=28). The following clinical situations were noted: Pediatric risk of mortality III (PRISM III) and pediatric logistic organ dysfunction (PELOD) scores; need for mechanical ventilation; presence of septic shock; need for plasmapheresis and renal replacement therapy; and death. Results: Patients with sepsis had significantly increased HMGB1 levels compared with the healthy controls. Serum HMGB1 level was not associated with PELOD and PRISM scores (p>0.05). Serum HMGB1 levels were higher in patients with mortality than in those who survived, but the difference was not statistically significant. Conclusion: Our study results showed that serum HGMB1 levels were higher in children with sepsis than in healthy children, and HMGB1 levels were also higher in patients with septic shock than in those without shock. More research is required to determine the response to therapy in children with sepsis in the pediatric critical care unit by serially measuring serum HGMB1 levels during the follow-up period.