Mori Hirotaka, Kataoka Yuki, Harada-Shirado Kayo, Kawano Noriaki, Hayakawa Mineji, Seki Yoshinobu, Uchiyama Toshimasa, Yamakawa Kazuma, Ishikura Hiroyasu, Irie Yuhei, Nishio Kenji, Yada Noritaka, Okamoto Kohji, Yamada Shingo, Ikezoe Takayuki
Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.
Thromb J. 2022 Jun 13;20(1):33. doi: 10.1186/s12959-022-00390-2.
We compared the prognostic value of serum high mobility group box 1 protein (HMGB1) and histone H3 levels with the International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) scores for 28-day in-hospital mortality in patients with DIC caused by various underlying diseases.
We conducted a multicenter prospective cohort study including two hematology departments, four emergency departments, and one general medicine department in Japan, between August 2017 and July 2021. We included patients diagnosed with DIC by the ISTH DIC scoring system.
Overall, 104 patients were included: 50 with hematopoietic disorders, 41 with infections, and 13 with the other diseases. The 28-day in-hospital mortality rate was 21%. The receiver operator characteristic (ROC) curve showed that a DIC score of 6 points, serum HMGB1 level of 8 ng/mL, and serum histone H3 level of 2 ng/mL were the optimal cutoff points. The odds ratios of more than these optimal cutoff points of the DIC score, serum HMGB1, and histone H3 levels were 1.58 (95% confidence interval [CI]: 0.60 to 4.17, p = 0.36), 5.47 (95% CI: 1.70 to 17.6, p = 0.004), and 9.07 (95% CI: 2.00 to 41.3, p = 0.004), respectively. The area under the ROC curve of HMGB1 (0.74, 95% CI: 0.63 to 0.85) was better than that of the ISTH DIC scores (0.55, 95% CI: 0.43 to 0.67, p = 0.03), whereas that of histone H3 was not (0.71, 95% CI: 0.60 to 0.82, p = 0.07). Calibration and net reclassification plots of HMGB1 identified some high-risk patients, whereas the ISTH DIC scores and histone H3 did not. The category-free net reclassification improvement of HMGB1 was 0.45 (95% CI: 0.01 to 0.90, p = 0.04) and that of histone H3 was 0.37 (95% CI: - 0.05 to 0.78, p = 0.08).
Serum HMGB1 levels have a prognostic value for mortality in patients with DIC. This finding may help physicians develop treatment strategies.
我们比较了血清高迁移率族蛋白B1（HMGB1）和组蛋白H3水平与国际血栓与止血学会（ISTH）弥散性血管内凝血（DIC）评分对各种基础疾病所致DIC患者28天院内死亡率的预后价值。
2017年8月至2021年7月，我们在日本开展了一项多中心前瞻性队列研究，纳入了两个血液科、四个急诊科和一个普通内科。我们纳入了通过ISTH DIC评分系统诊断为DIC的患者。
共纳入104例患者：50例患有造血系统疾病，41例患有感染，13例患有其他疾病。28天院内死亡率为21%。受试者工作特征（ROC）曲线显示，DIC评分为6分、血清HMGB1水平为8 ng/mL和血清组蛋白H3水平为2 ng/mL为最佳截断点。DIC评分、血清HMGB1和组蛋白H3水平超过这些最佳截断点的比值比分别为1.58（95%置信区间[CI]：0.60至4.17，p = 0.36）、5.47（95%CI：1.70至17.6，p = 0.004）和9.07（95%CI：2.00至41.3，p = 0.004）。HMGB1的ROC曲线下面积（0.74，95%CI：0.63至0.85）优于ISTH DIC评分（0.55，95%CI：0.43至0.67，p = 0.03），而组蛋白H3的则不然（0.71，95%CI：0.60至0.82，p = 0.07）。HMGB1的校准和净重新分类图识别出了一些高危患者，而ISTH DIC评分和组蛋白H3则未识别出。HMGB1的无类别净重新分类改善为0.45（95%CI：0.01至0.90，p = 0.04），组蛋白H3的为0.37（95%CI：-0.05至0.78，p = 0.08）。
血清HMGB1水平对DIC患者的死亡率具有预后价值。这一发现可能有助于医生制定治疗策略。
