title: Plasma levels of high mobility group box 1 increase in patients with posttraumatic stress disorder after severe blunt chest trauma: a prospective cohort study.
abstract: BACKGROUND
  High-mobility group box 1 (HMGB1), a key late mediator of systemic inflammation, is a potentially useful biomarker for predicting outcome in patients with severe blunt chest trauma. The purpose of this study was to define the relationship between plasma levels of HMGB1 and posttraumatic stress disorder (PTSD) in patients with severe blunt chest trauma.
  
  
  METHODS
  All patients with severe blunt chest trauma (abbreviated injury score ≥3) who were admitted to traumatic surgery department and ultimately survived to follow-up at 6 mo were eligible for the study. HMGB1 was sampled every other day from day 1-day 7 after admission, and plasma concentrations of HMGB1 were measured by a quantitative enzyme-linked immunosorbent assay test. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis.
  
  
  RESULTS
  PTSD was identified in 43 patients including acute PTSD (n = 21), chronic PTSD (n = 18), and delayed-onset PTSD (n = 4) after 6-mo follow-up, in whom significant higher plasma levels of HMGB1 on days three, five, and seven after blunt chest trauma were noted compared with those seen in patients without PTSD (n = 10). Multivariate logistic analysis showed that transfusion, injury severity score, and HMGB1 levels at day 7 were the valuable risk factors for PTSD.
  
  
  CONCLUSIONS
  In blunt chest trauma, plasma HMGB1 levels were significantly higher in patients with PTSD compared with patients with non-PTSD. Our data indicate that patients with high plasma levels of HMGB1 may be more prone to develop PTSD including acute and chronic PTSD.
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Xiao-Wen
authors.initials: XW
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Avash
authors.initials: A
authors.lastname: Karki
authors.affiliation: Department of Traumatic Surgery, Chongqing Institute of Accident and Emergency Medicine, Chongqing Emergency Medical Center, Chongqing, China.
authors.forename: Ding-Yuan
authors.initials: DY
authors.lastname: Du
authors.affiliation: Department of Traumatic Surgery, Chongqing Institute of Accident and Emergency Medicine, Chongqing Emergency Medical Center, Chongqing, China.
authors.forename: Xing-Ji
authors.initials: XJ
authors.lastname: Zhao
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Xiao-Yong
authors.initials: XY
authors.lastname: Xiang
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: lzqsurgery@163.com.
authors.forename: Zhi-Qian
authors.initials: ZQ
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D024243:HMGB1 Protein / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000097:blood*; D013898:Thoracic Injuries / Q000097:blood* / Q000175:diagnosis; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D024243:HMGB1 Protein; C585491:HMGB1 protein, human
keywords: Chest trauma; High-mobility group box 1; Inflammation; Post-traumatic stress disorder