Serum high-mobility group box-1 protein as a specific marker of severe abdominal injury

Introduction

Trauma cases who have altered consciousness are candidates for missed injury of the abdomen. A specific marker of severe abdominal trauma would therefore be considered useful for rapid evaluation and treatment of abdominal injuries in trauma cases. On the other hand, high-mobility group box-1 protein (HMGB1) has been widely studied in relation to its role in sepsis and inflammation [1, 2].

Methods

We measured the serum HMGB1 concentrations in 50 consecutive trauma patients as early as possible after they arrived in the emergency room. All cases with an abbreviated injury scale over 3 were enrolled in the study. The correlations between the serum HMGB1 levels and the body region of injury were examined. Then, a comparative evaluation of the injury severity score, revised trauma score and probability of survival was conducted in the patients with and without elevated serum HMGB1 concentrations. In addition, we measured the serum HMGB1 levels in 45 septic shock patients and the relationship between the HMGB1 level and underlying disease.

Results

There were no significant correlations between the serum HMGB-1 levels and the presence of severe head, chest or extremity injury. On the other hand, the serum HMGB1 levels were significantly higher in the subject group with severe abdominal injury (mean HMGB-1 level, 16.9 ng/ml; 10 cases) as compared with that in the subject group without severe abdominal injury (mean HMGB-1 level, 2.2 ng/ml; 40 cases) (P = 0.0069). In septic shock patients, the serum HMGB1 levels were significantly higher in the subject group with peritonitis (mean HMGB-1 level, 19.1 ng/ml; 22 cases) as compared with that in the subject group without peritonitis (mean HMGB-1 level, 8.8 ng/ml; 23 cases) (P = 0.0447).

Conclusion

According to our data, high serum levels of HMGB1 were not correlated with an increased likelihood of head injury, chest injury or extremity injury, but were significantly correlated with the presence of severe abdominal injury. This result suggests the possibility of the serum HMGB-1 level representing a specific marker of severe abdominal injury.