A study on the correlation between plasma exosomal histone H3 levels and coagulopathy in patients with heat stroke

Li Yue; Zhang Chengbin; Liu Shuai; Tang Youqing; Li Guanming

doi:10.3969/j.issn.1002-1949.2025.10.013

Abstract：Objective To investigate whether plasma exosomal histone H3 could be used to predict the occurrence of heat stroke(HS)complicated by disseminated intravascular coagulation(DIC).Methods Peripheral blood was collected from 50 HS patients(21 with DIC and 29 without DIC)that were admitted to the intensive care unit on Days 1 and 4 and from 30 healthy volunteers.Plasma exosomes were isolated by ultra-high-speed differential centrifugation,and the levels of histone H3 were measured.The correlation between plasma exosomal histone H3 level and the coagulation parameters and occurence of DIC was analyzed.Results Plasma exosome histone H3 levels were significantly higher in the HS complicated by DIC group[(501.9±203.1)pg/100 μg on Day 1 and(639.1±271.5)pg/100 μg on Day 4]than in the HS uncomplicated by DIC group[(186.2±35.5)pg/100 μg on Day 1,P<0.001 and(148.1±29.4)pg/100 μg on Day 4,P<0.001]and healthy controls[(137.8±40.0)pg/100 μg on Day 1,P<0.001 and(140.6±34.6)pg/100 μg on Day 4,P<0.001].There was no significant difference in plasma exosome histone H3 levels on Days 1 and 4(P>0.05)between patients with uncomplicated HS and healthy controls.Plasma exosome histone protein H3 was significantly higher in the HS complicated by DIC group on Day 4 than on Day 1(P<0.01),but there was no significant change in the uncomplicated HS group(P>0.05).Plasma exosomal histone H3 levels were significantly correlated with coagulation markers and ISTH scores(P<0.001).The area under the receiver operating characteristic(ROC)curve for plasma exosomal histone H3 levels predicting the occurrence of DIC was 1.000[95%confidence interval(CI)1.000-1.000,P<0.001].The sensitivity and specificity for predicting the occurrence of DIC were both 100%at a threshold of 291.5 pg/100 μg.Conclusions Plasma exosomal histone H3 may be a reliable biomarker for HS complicated by DIC.