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Relationship between the presence of serum high-mobility-group box protein 1 and the injury severity score in trauma patients


High-mobility-group box protein 1 (HMGB1) is a highly conserved, ubiquitous protein present in the nuclei and cytoplasm of nearly all cell types and, secreted into the extracellular milieu, acts as a proinflammatory cytokine. The function of HMGB1 has been widely studied for sepsis and inflammation. HMGB1 was reported as a late mediator in endotoxic shock and was known as an abundant protein present in nuclei and cytoplasm and involved in maintaining nucleosome structure and regulation of gene transcription. Moreover, elevated, circulating levels of HMGB1 also have been described in a case of human hemorrhagic shock due to abdominal aortic aneurysm without evidence of infection. However, the relationship between HMGB1 and trauma has not been studied except for the report of a rat model of burn.

Materials and methods

The study cases consisted of 20 trauma patients who were admitted to the emergency room by ambulance. As soon as they arrived in the emergency room, their blood sample were collected, centrifuged, and stored at -80°C. The serum HMGB1 concentration was measured by ELISA. We compared the injury severity score (ISS), probability of survival values and the revised trauma score (RTS) of the patients with the presence of serum HMGB1 (group A) and without the presence (group B). We therefore divided into two groups, high ISS group (≤25) and low ISS group (>25), and examined the relation with the serum HMGB1 level.


Our data showed that the number in group A was nine cases and group B was 11 cases. The ISS of group A was significantly higher than that in group B (P = 0.0013). The P value of group A was significantly lower than in group B (P = 0.0131). The serum HMGB1 level of the >25 ISS group was significantly higher than in the ≤25 ISS group.


These data suggest that HMGB1 seems to be a primary mediator of trauma-induced pathology. Because the ISS was significantly correlated with the presence of serum HMGB1, HMGB1 may be expressed in severe injuries and it may be a important parameter that indicates the severity of injury.

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Sakamoto, Y., Mashiko, K., Matsumoto, H. et al. Relationship between the presence of serum high-mobility-group box protein 1 and the injury severity score in trauma patients. Crit Care 11 (Suppl 2), P26 (2007).

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