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

Abstract 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 s 95% CI 0.46 0.28–0.61; p s 0.46 0.27–0.61; p s 0.48 0.30–0.62; p s 0.48 0.32–0.62; p Registration date: June 4, 2019