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Elevated HMGB1 levels correlate with sepsis diagnosis and increased mortality risk in adult patientsHigh HMGB1 levels linked to sepsis and higher mortality

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Key Takeaway
Note that elevated HMGB1 levels are associated with sepsis diagnosis and higher risk of mortality in adult patients.

This meta-analysis evaluated the association between high mobility group box-1 (HMGB1) levels in serum or plasma and both sepsis diagnosis and mortality risk among 3,110 adult patients. The analysis compared sepsis patients against healthy controls, non-sepsis controls, and survivors of sepsis.

The synthesis found that HMGB1 levels were significantly increased in sepsis patients compared to healthy controls (P < 0.001). While the difference between sepsis patients and non-sepsis controls was not statistically significant (P = 0.081), a significant elevation in HMGB1 levels was observed in non-survivors compared to survivors of sepsis (P = 0.030).

The authors noted that publication bias existed regarding the differences in HMGB1 between sepsis patients and controls, which was addressed using trim-and-fill methods. These findings suggest that HMGB1 may serve as a potential biomarker for diagnosing sepsis and stratifying mortality risk. However, these associations do not imply causality, and further research is needed to establish clinical utility.

How this fits prior evidence

This meta-analysis addresses a gap in identifying biomarkers for sepsis diagnosis and mortality risk stratification. While previous evidence noted that sepsis mortality prediction models have moderate accuracy (AUC 0.79) but are limited by high bias, this study identifies HMGB1 as a potential biomarker for risk stratification. Additionally, while Cystin C shows good diagnostic performance (AUC 0.88) for early detection of SA-AKI, the findings here focus on the specific role of HMGB1 in identifying sepsis and predicting mortality.

Sepsis is a life-threatening medical emergency, and identifying early warning signs is critical for patient survival. A study of over 3,000 adult patients looked at HMGB1, a protein that can act as a signal in the body's inflammatory response.

The researchers found that patients with sepsis had significantly higher levels of this protein compared to healthy individuals. More importantly, those who did not survive from sepsis showed even higher levels of HMGB1 than those who did survive. This suggests the protein could help doctors identify high-risk patients more quickly.

While these results are promising for developing new ways to track disease severity, it is important to note that this study shows an association rather than a direct cause. Because some publication bias was noted in the data, researchers continue to work on refining how they use these markers to improve patient care.

What this means for you:
Higher HMGB1 protein levels are linked to sepsis diagnosis and higher risk of death.

Common questions

What is HMGB1 and why does it matter in sepsis?

HMGB1 is a protein that can act as a marker in the body. This study found that levels of this protein are significantly higher in patients with sepsis compared to healthy people. Because these levels are also higher in patients who do not survive, it may help doctors identify which patients are at the highest risk for serious complications.

Can HMGB1 be used to tell if a patient will survive sepsis?

The study found that patients who did not survive from sepsis had significantly higher levels of HMGB1 than those who did survive. While this suggests the protein could help with risk stratification, it is currently an association only and not a definitive way to predict individual outcomes. You should speak with a doctor about specific clinical applications.

How many patients were included in this study?

The analysis included data from 3,110 adult patients. By looking at such a large group, researchers were able to confirm that HMGB1 levels are significantly higher in sepsis patients compared to healthy controls (P < 0.001) and those who did not survive (P = 0.030).

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
High mobility group box-1 (HMGB1) regulates inflammation, immune response, DNA repair, and cell death, which is crucial in the pathogenesis of sepsis; while its role in sepsis susceptibility and mortality risk remains inconsistent. Hence, this meta-analysis systemically investigated the dysregulation level of HMGB1 and its association with mortality risk. PubMed, Web of Science, Embase, and Cochrane Library databases were searched until May 2024. Studies written in English and comparing HMGB1 level in serum or plasma detected by enzyme-linked immunosorbent assay between adult sepsis patients and controls, or non-survivors and survivors of sepsis, were eligible. Twenty-eight studies containing 3,110 subjects were included. The quality of studies was satisfactory evaluated by the Newcastle-Ottawa scale. Pooled analyses showed that HMGB1 was increased in sepsis patients versus controls (P < 0.001). Subgroup analysis revealed that HMGB1 was increased in sepsis patients versus healthy controls (P < 0.001), but less varied between sepsis patients and non-sepsis controls (P = 0.081). Additionally, HMGB1 was elevated in non-survivors versus survivors of sepsis (P = 0.030). Publication bias existed in HMGB1 differences between sepsis patients and controls; but it was adjusted using the trim-and-fill method, and the statistical significance did not change after that. Sensitivity analysis indicated acceptable robustness. In conclusion, this study suggests the potential of HMGB1 to serve as a possible biomarker for sepsis diagnosis and mortality risk stratification.
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