ABSTRACT
Objective: To analyze the influence of serum high mobility group box-1 protein (HMGB1) levels on the severity and prognosis of critical ill patients at the early of trauma-induced coagulopathy (TIC) in intensive care unit (ICU). Methods: 43 cases of critical ill patients with severe trauma were included during January 1, 2017 to December 31, 2018 in ICU of Foshan Hospital of Traditional Chinese Medicine. International normalized ratio (INR) >1.2 was applied as the diagnosis criterion of TIC. The patients was divided into TIC group (n=23) and control group (n=20). Their age, sex, injury mechanism, the interval between injury and admission to ICU (delay time), the interval between injury and coagulopathy correction (correction time), ISS scores, APACHE II scores at admission to ICU were recorded, and the activated partial thromboplastin time (APTT), prothrombin time (PT), INR, fibrinogen (Fib), platelet counts (PLT), C-reactive protein (CRP) and procalcitonin (PCT) levels were detected meanwhile. The serum HMGB1 levels were examined through ELISA. The blood transfusion volume (red blood cells, RBC and fresh frozen plasma, FFP), ventilation time, ICU stay and 28-day mortality rate were statistically analyzed. Results: TIC occurred in 53.5% of critical ill trauma patients in ICU. There were no significant differences in the age, sex, injury mechanism, delay time, APACHE II scores, ISS scores, APTT, PT, CRP and PCT levels between two groups (P>0.05). Compared with control group, the Fib and PLT levels were significantly reduced in the TIC group, and the ventilation time, blood transfusion volume of RBC and FFP, infection rate and organ dysfunction rate were remarkably increased (P<0.05). Besides, the 28-day mortality rate revealed a raised tendency in TIC group (P=0.091). Simultaneously, the serum HMGB1 levels at admission to ICU were significantly increased in the TIC group, and the serum HMGB1 level in the death subgroup was much higher than that in the survivors, as same as those in the TIC subgroup analysis (P=0.000). The correlation analysis disclosed that serum HMGB1 levels at admission was positively related to delay time, correction time, APACHE II score, ISS score, ventilation time, INR levels, APTT, CRP and PCT levels at admission (r=0.648, 0754, 0.526, 0.516, 0.521, 0.509, 0.432, 0.592, 0.375), and was negatively associated with Fib levels, PLT value, infection incidence rate, organ dysfunction rate and 28-day mortality rate (r=-0.424, -0.571, -0.505, -0.396, -0.765). There were significant differences in the delay time, correction time, ISS scores, transfusion volume, serum HMGB1 levels, PLT value, APTT and CRP levels between death subgroup and survivor subgroup of TIC patients (P<0.05), and serum HMGB1 levels and PLT value at admission were independent risk factors in the multivariable logistic regression analysis (P=0.004, 0.011). For the TIC sub-group trauma patients, the AUC of serum HMGB1 levels was 0.897(95%CI 0.748-1.000, P=0.002), the best cutoff value was 54.60 ng/ml with Youden index of 0.808. Conclusions: The PLT levels and serum HMGB1 levels at admission to ICU are independent risk factors of critical ill patients with severe trauma. The serum HMGB1 levels is closely related to severity and prognosis, and can predict the 28-day mortality rate of critical ill patients with TIC.