Impact of serum high-mobility group box 1 protein elevation on oxygenation impairment after thoracic aortic aneurysm repair.
High-mobility group box 1 protein (HMGB1) is a late mediator of inflammatory responses that can cause acute lung injury. We examined the significance of serum HMGB1 elevation in the development of systemic inflammatory response syndrome (SIRS) and lung oxygenation impairment (LOI) after thoracic aortic aneurysm (TAA) repair. Serial measurements of the serum HMGB1 level and SIRS score for 7 days after surgery were determined in 20 patients with TAA who underwent surgical repair. Arterial oxygen tension was measured serially for at least 4 days after surgery, and LOI was defined as the lowest PaO(2)/FiO(2) ratio ≤ 200 mmHg. The serum HMGB1 level was markedly increased after surgery, peaking on day 2, and remained significantly elevated on day 7. Peak HMGB1 level positively correlated with SIRS duration and the cumulative SIRS score during postoperative days 1-7 (P = 0.0013 and P = 0.0004, respectively). Peak HMGB1 level and cumulative SIRS score were higher in patients with LOI than in those without (P = 0.01 and P = 0.044, respectively). Peak HMGB1 level was negatively correlated with the lowest PaO(2)/FiO(2) ratio (P = 0.0077) and positively correlated with postoperative length of hospitalization (P = 0.042). A greater serum HMGB1 elevation after TAA repair was associated with more severe SIRS and a higher incidence of LOI. HMGB1 might play a key role in the pathogenesis of SIRS and LOI after surgical TAA repair.
Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Takashi
T
Kohno
Toshihisa
T
Anzai
Hideyuki
H
Shimizu
Hidehiro
H
Kaneko
Yasuo
Y
Sugano
Shingo
S
Yamada
Tsutomu
T
Yoshikawa
Akitoshi
A
Ishizaka
Ryohei
R
Yozu
Satoshi
S
Ogawa
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D024243:HMGB1 Protein / Q000097:blood*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007564:Japan; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010100:Oxygen / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D024243:HMGB1 Protein; D018836:Inflammation Mediators; D010100:Oxygen