Association of high mobility group box B1 and Toll-like receptor 4 axis with the risk and prognosis of ARDS in sepsis patients

Zhang Zhibin; Li Ruitong; Zheng Weiwei; Lin Xuerong; Niu Ningning; Wang Hui; Yuan Meng; Han Shuchi; Xue Qianlong

doi:10.3969/j.issn.1002-1949.2024.08.004

Abstract：Objective To investigate the association of high mobility group box B1(HMGB1)and Toll-like receptor 4(TLR4)axis with the risk and prognosis of acute respiratory distress syndrome(ARDS)in sepsis patients.Methods A total of 176 patients with sepsis admitted to the First Affiliated Hospital of Hebei North University from June 2022 to October 2023 were selected and divided into ARDS group(n=58)and non-ARDS group(n=112)according to whether ARDS occurred.The prognosis of ARDS patients with sepsis was evaluated according to 28 d survival status.Venous blood was collected and serum was separated within 24 h after admission,the contents of HMGB1,TLR4,nuclear factor-κB(NF-κB)and tumor necrosis factor-α(TNF-α)were detected.The differences of clinical data and serum indexes between the two groups were compared.The influencing factors of ARDS in sepsis patients were analyzed by multivariate Logistic regression.The diagnostic indexes and prognostic indexes of ARDS in sepsis patients were analyzed by receiver operating characteristic(ROC)curve.Results Age,C-reactive protein(CRP),procalcitonin(PCT),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and serum HMGB1,TLR4,NF-κB and TNF-α contents in ARDS group were higher than those in non-ARDS group(t=3.007,4.423,7.413,8.069,16.955,9.072,4.751,8.569,P＜0.05).HMGB1,TLR4,TNF-α and APACHE Ⅱ scores were the influencing factors of ARDS in sepsis patients(Wald x2=18.284,11.878,13.248,12.620,P＜0.05).The diagnostic and predictive values of the combined indexes were better than those of the single index.Conclusions Both HMGB1 and downstream TLR4 axis are overexpressed in sepsis patients with ARDS.The combination of serum HMGB1,TLR4,TNF-α and APACHE Ⅱ score has good diagnostic value and prognostic value for the ARDS patients with sepsis.