Evaluation of serum HMGB1 levels in assessing the severity of pediatric sepsis and analysis of the therapeutic efficacy of blood purification modalities

BACKGROUND: High Mobility Group Box 1 protein (HMGB1) plays a critical role in the pathogenesis of sepsis. However, its value in assessing disease severity and its relationship with blood purification therapy in pediatric sepsis remains underexplored. OBJECTIVE: This study aims to investigate the value of serum HMGB1 in evaluating the severity of pediatric sepsis and its association with blood purification treatment. METHODS: A retrospective observational cohort study was conducted. This study included 90 pediatric patients with sepsis and 21 healthy controls admitted from March 2022 to December 2023. Patients were stratified into a mild-severity group (n = 44) and a severe-severity group (n = 46) based on clinical criteria. Among the severe patients, 21 received continuous renal replacement therapy (CRRT). Of these, 6 were treated with a single-mode (CHDF) and 15 with a mixed-mode (CHDF + PE) blood purification strategy. Serum HMGB1 levels were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum HMGB1 levels were significantly higher in the sepsis group compared to the healthy control group (P < 0.001). Within the sepsis cohort, HMGB1 levels were significantly elevated in the severe group versus the mild group (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that HMGB1 had an area under the curve (AUC) of 0.921 for diagnosing severe sepsis, demonstrating superior performance compared to other inflammatory markers. CRRT treatment was associated with a significant reduction in HMGB1 and other inflammatory markers (P < 0.001). The survival rate in the mixed-mode treatment group was significantly higher than that in the single-mode group (86.7% vs. 16.7%, P = 0.006). CONCLUSION: Serum HMGB1 levels are significantly associated with the severity of pediatric sepsis and show promising diagnostic value. Blood purification treatment is associated with a reduction in HMGB1 levels; however, the underlying mechanisms require further investigation.