Emergency Medicine: Open Access
Open Access

Abstract

HMGB-1 Levels May be Markers of Haematological Dysfunction after Severe Trauma

António Sousa, Jose Artur Paiva, Sara Fonseca, Luís Valente, Frederico Raposo, Moura Gonçalves and Luis de Almeida

Introduction: HMGB-1 is a nuclear protein that acts as an alarmin to tissue repair in sepsis and is one of multiple mediators in the systemic inflammatory response (SIRS). Its role in clinical models of severe trauma is less well studied.
Objectives: The aim of this study was to study the release pattern of HMGB-1 in the first 72 hours after severe trauma and the association of HMGB-1 levels with tissue damage, shock, coagulation disorders and thrombocytopenia.
Materials and methods: A prospective cohort study enrolling all adult trauma patients with injury severity score (ISS)>15 admitted to a Trauma Room. Analytical variables assessed were: creatine kinase (CK), myoglobin (MIO) lactate, coagulation times and platelets at admission; HMGB-1 levels were measured at admission 24, 48 and 72h.
Results: Ninety-nine patients were enrolled with median ISS of 29, age 31 (18-60) years and 83% were male. Shock was found in 17%, hyperlactacidemia in 46%, coagulopathy in 26%, and thrombocytopenia in 19%. Outcomes were ICU admission-66%, MODS-34%, and Death-28%. The HMGB-1 highest level was found at admission. The study showed correlations between HMGB-1 and shock at admission (p<0,047), coagulopathy at 24h (p<0,01), and thrombocytopenia at 48h (p<0,026). Coagulopathy was associated with death and thrombocytopenia with ICU admission and death. HMGB-1 did not show correlation with ISS, CK or MIO or with any of the outcomes.
Conclusions: In this group of patients HMGB-1 levels at admission, at 24 h and at 48 h after severe trauma were respectively associated with the existence of shock, coagulopathy and thrombocytopenia.