Studies on the Balance between Thrombomodulin and HMGB1 in Sepsis Patients | Chapter 4 | Highlights on Medicine and Medical Science Vol. 7

 Background: In sepsis patients, the equilibrium between high mobility group box 1 (HMGB1) and thrombomodulin (TM) must be understood. The molecule HMGB1 has been linked to severe sepsis outcomes, and thrombomodulin (TM) appears to have an anti-inflammatory impact.

The goal of this study was to look at the relationship between the balance of high mobility group box 1 protein (HMGB1) and thrombomodulin (TM) in early sepsis and how it relates to clinic presentation and outcomes.

Methods: Twenty individuals with sepsis or septic shock were studied using the 2016 guidelines (SEPSIS-3). Patients were followed until they were discharged from the intensive care unit (ICU) or until they had spent 28 days in the hospital (D28). The following clinical outcomes were found: Time in mechanical pulmonary ventilation (MV); degree of hypoxemia; presence of septic shock; development of sepsis-induced coagulopathy (SIC); necessity for renal replacement treatment (RRT); and mortality. The findings revealed a positive connection between serum TM levels and the T/H ratio and SOFA score values, with r = 0.64 and 0.6, respectively. The T/H ratio had a positive relationship with MV time and a negative relationship with hypoxemia degree (r = 0.35 and - 0.39, respectively). INR values were positively connected to serum TM levels, while platelet count values were adversely related (r = 0.53 and - 0.47, respectively). The presence of CIS was linked to higher TM and T/H ratio values (p = 0.007 and 0.034, respectively). In patients requiring RRT, the T/H ratio was three times greater on average (0.38 0.14 versus 0.11 0.09), p0.001.

Conclusions: Although blood levels of HMGB1 were not related with increased severity of sepsis in the first 24 hours after diagnosis, serum levels of TM were. Larger TM levels in the blood and, as a result, a higher T / H ratio, were linked to higher SOFA scores, longer MV times, and more severe hypoxemia, as well as the presence of CIS and the necessity for RRT. Patients who were released before the 28-day mark, on the other hand, had lower T/H ratios.

Author (S) Details

Adriana Teixeira Rodrigues
Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.

Julia Teixeira Rodrigues
Department of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil.

Carolina Teixeira Rodrigues
Department of Internal Medicine, Unimed Hospital, Belo Horizonte 30150-340, Minas Gerais, Brazil.

Jose Augusto Nogueira-Machado
Graduation Program in Medicine/Biomedicine - Santa Casa Hospital - Education and Research, Belo Horizonte 30150-240, Minas Gerais, Brazil.

Luiz Ronaldo Alberti
Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30220-000, Minas Gerais, Brazil.

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