The predictive value of serum HMGB1 and sRAGE in the occurrence and short-term prognosis of sepsis-associated encephalopathy

doi:10.11958/20242152

Abstract

Abstract:

Objective To explore the predictive value of serum high-mobility group box protein B1 (HMGB1) and soluble receptor for advanced glycation end-products (sRAGE) in the occurrence and short-term prognosis of sepsis-associated encephalopathy (SAE). Methods Clinical data of 228 patients with sepsis were retrospectively analyzed. According to the presence of SAE, patients were divided into the SAE group (96 cases) and the non-SAE group (132 cases). General clinical data, laboratory test results, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores, Sequential Organ Failure Assessment (SOFA) scores and serum HMGB1 and sRAGE levels were compared between the two groups. Multivariate Logistic regression analysis was performed to determine factors influencing SAE occurrence. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive ability of HMGB1, sRAGE and the HMGB1/sRAGE ratio to predict the occurrence and short-term prognosis of SAE. Kaplan-Meier survival curves were used to compare the 28-day mortality rates of SAE patients with different HMGB1 and sRAGE expression levels. Results Compared to the non-SAE group, patients in the SAE group exhibited elevated serum HMGB1 levels, decreased sRAGE levels and an increased HMGB1/sRAGE ratio (P<0.05). The areas under the curve (AUC) for predicting SAE using HMGB1, sRAGE and the HMGB1/sRAGE ratio were 0.826 (95% CI: 0.770-0.872), 0.682 (95% CI: 0.617-0.742) and 0.895 (95% CI: 0.848-0.932), respectively, indicating predictive value. Among the 96 SAE patients, 52 (54.2%) died within 28 days. There were no statistically significant differences in HMGB1, sRAGE and the HMGB1/sRAGE ratio between surviving and deceased patients (P>0.05). Similarly, there were no significant differences in 28-day mortality rates between SAE patients with different HMGB1 or sRAGE expression levels. Conclusion Elevated serum HMGB1 and reduced sRAGE are of significant value in the auxiliary diagnosis of SAE, but have limited clinical predictive value for short-term prognosis.

Key words: sepsis-associated encephalopathy, HMGB1 protein, receptor for advanced glycation end products, prognosis

CLC Number:

R631.3，R742

Figures/Tables 6

References 20

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组别	n		年龄/ 岁	BMI/ （kg/m²）		男性	糖尿病		高血压		APACHEⅡ 评分/分		SOFA 评分/分	CRP/ （mg/L）		PCT/ （μg/L）		TNF-α/ （ng/L）		IL-6/ （ng/L）
非SAE组	132		60.8±9.9	23.7±3.1		79（59.8）	25（18.9）		49（37.1）		18.2±3.8		6.1±2.0	65.3±18.2		1.2±0.5		22.5±6.3		35.8±9.4
SAE组	96		63.7±11.1	24.3±3.4		57（59.4）	22（22.9）		41（42.7）		21.5±5.2		8.9±3.2	89.7±22.6		3.4±1.1		35.4±8.7		62.3±15.6
t或χ2			2.075^＊	1.462		0.005	0.517		0.574		5.538^＊＊		8.111^＊＊	9.021^＊＊		20.288^＊＊		12.989^＊＊		15.945^＊＊
组别		脑脊液葡萄糖/（mmol/L）			脑脊液蛋白/（g/L）			HMGB1/ （μg/L）		sRAGE/ （ng/L）		HMGB1/ sRAGE			乳酸/ （mmol/L）		白蛋白/ （g/L）		肌酐/ （μmol/L）
非SAE组		3.4±0.8			0.45±0.12			40.9±9.8		1 204.1±290.3		0.034±0.011			2.1±0.8		35.2±3.1		112.3±23.5
SAE组		2.9±0.6			0.69±0.18			58.8±15.1		988.3±242.2		0.059±0.014			2.9±1.2		32.4±2.9		145.7±31.2
t		5.158^＊＊			12.072^＊＊			10.841^＊＊		5.934^＊＊		14.522^＊＊			6.036^＊＊		6.918^＊＊		9.220^＊＊

组别	n		年龄/ 岁	BMI/ （kg/m²）		男性	糖尿病		高血压		APACHEⅡ 评分/分		SOFA 评分/分	CRP/ （mg/L）		PCT/ （μg/L）		TNF-α/ （ng/L）		IL-6/ （ng/L）
非SAE组	132		60.8±9.9	23.7±3.1		79（59.8）	25（18.9）		49（37.1）		18.2±3.8		6.1±2.0	65.3±18.2		1.2±0.5		22.5±6.3		35.8±9.4
SAE组	96		63.7±11.1	24.3±3.4		57（59.4）	22（22.9）		41（42.7）		21.5±5.2		8.9±3.2	89.7±22.6		3.4±1.1		35.4±8.7		62.3±15.6
t或χ2			2.075^＊	1.462		0.005	0.517		0.574		5.538^＊＊		8.111^＊＊	9.021^＊＊		20.288^＊＊		12.989^＊＊		15.945^＊＊
组别		脑脊液葡萄糖/（mmol/L）			脑脊液蛋白/（g/L）			HMGB1/ （μg/L）		sRAGE/ （ng/L）		HMGB1/ sRAGE			乳酸/ （mmol/L）		白蛋白/ （g/L）		肌酐/ （μmol/L）
非SAE组		3.4±0.8			0.45±0.12			40.9±9.8		1 204.1±290.3		0.034±0.011			2.1±0.8		35.2±3.1		112.3±23.5
SAE组		2.9±0.6			0.69±0.18			58.8±15.1		988.3±242.2		0.059±0.014			2.9±1.2		32.4±2.9		145.7±31.2
t		5.158^＊＊			12.072^＊＊			10.841^＊＊		5.934^＊＊		14.522^＊＊			6.036^＊＊		6.918^＊＊		9.220^＊＊

变量	B	SE	Wald χ2	P	OR	OR 95% CI
APACHEⅡ评分	0.243	0.063	14.986	<0.001	1.275	1.127~1.441
SOFA评分	0.336	0.086	15.289	<0.001	1.400	1.187~1.650
PCT	1.785	0.312	32.684	<0.001	5.960	3.226~11.009
HMGB1/sRAGE	1.895	0.717	13.435	<0.001	6.653	2.415~18.326
白蛋白	-0.297	0.073	16.462	<0.001	0.743	0.654~0.844
肌酐	0.027	0.006	22.334	<0.001	1.027	1.016~1.039
常数项	0.258	0.196	1.733	0.188	1.294

变量	B	SE	Wald χ2	P	OR	OR 95% CI
APACHEⅡ评分	0.243	0.063	14.986	<0.001	1.275	1.127~1.441
SOFA评分	0.336	0.086	15.289	<0.001	1.400	1.187~1.650
PCT	1.785	0.312	32.684	<0.001	5.960	3.226~11.009
HMGB1/sRAGE	1.895	0.717	13.435	<0.001	6.653	2.415~18.326
白蛋白	-0.297	0.073	16.462	<0.001	0.743	0.654~0.844
肌酐	0.027	0.006	22.334	<0.001	1.027	1.016~1.039
常数项	0.258	0.196	1.733	0.188	1.294

组别	n	HMGB1/（μg/L）	sRAGE/（ng/L）	HMGB1/sRAGE
存活组	44	57.1±16.6	1 001.8±199.3	0.057±0.014
死亡组	52	60.3±13.7	976.9±274.8	0.062±0.013
t		1.034	0.500	1.813