HMGB-1 as a predictor of massive transfusion protocol activation in major trauma: a prospective observational study Article Swipe

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Michal Frelich , Marek Bebej , Jan Pavlíček , Filip Burša , Vojtěch Vodička , Zdeněk Švagera , Adéla Kondé , Ondřej Jor , Peter Sklienka ·

YOU? · · 2024 · Open Access · · DOI: https://doi.org/10.21203/rs.3.rs-4734362/v1

Background Massive bleeding causes approximately 50% of deaths in patients with major trauma. Most patients die within 6 hours of injury, which is preventable in at least 10% of cases. For these patients, early activation of the massive transfusion protocol (MTP) is a critical survival factor. With severe trauma, high-mobility group box 1 (HMGB-1, i.e., amphoterin) is released into the blood, and its levels correlate with the development of a systemic inflammatory response, traumatic coagulopathy, and fibrinolysis. Previous work has shown that higher levels of HMGB-1 are associated with a higher use of red blood cell transfusions. We conducted a single-center, prospective, observational study to assess the value of admission HMGB-1 levels in predicting activation of MTP in the emergency department. Methods From July 11, 2019, to April 23, 2022, a total of 104 consecutive adult patients with severe trauma (injury severity score > 16) were enrolled. A blood sample was taken at admission, and HMGB-1 was measured. MTP activation in the emergency department was recorded in the study documentation. The total amount of blood products and fibrinogen administered to patients within 6 hours of admission was monitored. Results Among those patients with massive bleeding requiring MTP activation, we found significantly higher levels of HMGB-1 compared to patients without MTP activation (median [interquartile range]: 84.3 µg/L [34.2–145.9] vs. 21.1 µg/L [15.7–30.4]; p < 0.001). HMGB-1 level showed good performance in predicting MTP activation, with an area under the curve of 0.84 (95% CI 0.75–0.93) and a cut-off value of 30.55 µg/L. HMGB-1 levels correlated significantly with the number of red blood cell units (r_s [95% CI] 0.46 [0.28–0.61]; p < 0.001), units of fresh frozen plasma (r_s 0.46 [0.27–0.61]; p < 0.001), platelets (r_s 0.48 [0.30–0.62]; p < 0.001), and fibrinogen (r_s 0.48 [0.32–0.62]; p < 0.001) administered in the first 6 hours after hospital admission. Conclusions Admission HMGB-1 levels reliably predict MTP activation in the emergency department and correlate with the amount of blood products and fibrinogen administered during the first 6 hours of hemorrhagic shock resuscitation. Trial registration NCT03986736 Registration date: June 4, 2019

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Medicine Interquartile range Emergency department Coagulopathy Observational study Fibrinolysis Blood transfusion Prospective cohort study Injury Severity Score Trauma center Fibrinogen Internal medicine Surgery Emergency medicine Retrospective cohort study Poison control Injury prevention Psychiatry

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Type: preprint
Language: en
Landing Page: https://doi.org/10.21203/rs.3.rs-4734362/v1
PDF: https://www.researchsquare.com/article/rs-4734362/latest.pdf
OA Status: gold
References: 31
Related Works: 10
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DOI: https://doi.org/10.21203/rs.3.rs-4734362/v1

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Title: HMGB-1 as a predictor of massive transfusion protocol activation in major trauma: a prospective observational study

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Type: preprint

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Language: en

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Publication year: 2024

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Publication date: 2024-08-17

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Authors: Michal Frelich, Marek Bebej, Jan Pavlíček, Filip Burša, Vojtěch Vodička, Zdeněk Švagera, Adéla Kondé, Ondřej Jor, Peter Sklienka

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Landing page: https://doi.org/10.21203/rs.3.rs-4734362/v1

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Concepts: Medicine, Interquartile range, Emergency department, Coagulopathy, Observational study, Fibrinolysis, Blood transfusion, Prospective cohort study, Injury Severity Score, Trauma center, Fibrinogen, Internal medicine, Surgery, Emergency medicine, Retrospective cohort study, Poison control, Injury prevention, Psychiatry

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publication_date	2024-08-17
publication_year	2024
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abstract_inverted_index.4,	345
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abstract_inverted_index.an	235
abstract_inverted_index.at	26, 153
abstract_inverted_index.in	9, 25, 113, 118, 161, 167, 230, 299, 315
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abstract_inverted_index.of	7, 20, 29, 36, 69, 85, 93, 109, 116, 133, 174, 185, 204, 240, 249, 259, 273, 324, 335
abstract_inverted_index.to	105, 127, 180, 207
abstract_inverted_index.we	199
abstract_inverted_index.10%	28
abstract_inverted_index.104	134
abstract_inverted_index.11,	125
abstract_inverted_index.16)	145
abstract_inverted_index.23,	129
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abstract_inverted_index.MTP	117, 159, 197, 210, 232, 313
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abstract_inverted_index.0.46	267, 278
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abstract_inverted_index.0.84	241
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abstract_inverted_index.21.1	219
abstract_inverted_index.84.3	215
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abstract_inverted_index.With	47
abstract_inverted_index.[95%	265
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abstract_inverted_index.cell	96, 262
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abstract_inverted_index.into	59
abstract_inverted_index.that	82
abstract_inverted_index.were	146
abstract_inverted_index.with	11, 66, 89, 138, 193, 234, 256, 321
abstract_inverted_index.work	79
abstract_inverted_index.(MTP)	41
abstract_inverted_index.2019,	126
abstract_inverted_index.2022,	130
abstract_inverted_index.30.55	250
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abstract_inverted_index.least	27
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abstract_inverted_index.HMGB-1	86, 111, 156, 205, 225, 252, 309
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