Abstract Background: Prognostic assessment in sepsis relies on evaluating the dynamic progression of organ dysfunction and the inflammatory response. This study compared the predictive value of serially measured serum HMGB1, a key late mediator of sepsis, with the △SOFA score for 28-day mortality. Methods: This prospective cohort study enrolled 250 sepsis patients admitted to the emergency department of a tertiary hospital from January 2022 to August 2024. Serum HMGB1 levels and SOFA scores were dynamically assessed on days 1, 4, and 7. Receiver operating characteristic (ROC) curve analysis and Kaplan-Meier survival analysis were employed to evaluate their prognostic performance. The primary endpoint was 28-day all-cause mortality. Results: A total of 232 patients (median age 71.5 years, 56% male) with a 28-day mortality rate of 13.8% (32/232) were included. Non-survivors had a higher prevalence of autoimmune diseases (43.8% vs. 11.5%) and lung infections (81.3% vs. 47.0%). Serum HMGB1 levels peaked on day 4 and were significantly higher in non-survivors and septic shock patients (P Conclusion: Dynamic monitoring of serum HMGB1 provides valuable prognostic information. Specifically, the day 4 HMGB1 level demonstrates excellent and earlier predictive performance for 28-day mortality, even comparable to the D7-△SOFA score, highlighting its potential as a prognostic biomarker in sepsis. Clinical trial number: Not applicable.
Su et al. (Fri,) studied this question.