Serum HMGB1 as a biomarker and predictive model for pediatric septic shock: a cohort study

Background: Sepsis, defined as life-threatening organ dysfunction due to a dysregulated host response to infection, remains a leading cause of pediatric mortality. High mobility group box 1 (HMGB1), a late inflammatory mediator, has shown prognostic value in adult sepsis, but its utility in pediatric populations remains inadequately investigated. This study aimed to evaluate HMGB1 as a prognostic biomarker for septic shock in children with sepsis and to develop a clinical prediction model. Methods: In this prospective cohort study, we enrolled 46 pediatric patients (aged 1 month to 18 years) with sepsis and organ dysfunction at a tertiary hospital in China (March 2022 to December 2023). Serum HMGB1 levels were measured within 24 hours of admission. Patients were stratified into shock (n=17) and non-shock (n=29) groups. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance of HMGB1 and other biomarkers. Multivariable logistic regression identified independent predictors, which were integrated into a nomogram prediction model. Results: Septic shock developed in 17 patients (37.0%). The shock group exhibited significantly elevated levels of HMGB1, procalcitonin (PCT), serum amyloid A (SAA), interleukin-6 (IL-6), fibrin degradation products, and urea (all P