Role of high-mobility group box 1 in late onset neonatal sepsis

Neonatal sepsis is an important cause of morbidity and mortality. High mobility group box1 protein (HMGB1) is a cytokine that can mediate inflammation. The aim of this research was to investigate the role of HMGB1 in diagnosis and prognosis of late onset neonatal sepsis. This observational case-control study included 80 newborn infants ≥37 weeks of gestation. Newborn infants were assigned into two groups: the late-onset neonatal septic group included 40 infant cases, and the control group included 40 newborn infants. Clinical sepsis score, hematological sepsis score and serum level of C-reactive protein were assessed and blood culture performed. HMGB1 was measured by an enzyme-linked immunosorbent assay. There was a significant increase of HMGB1 in the late-onset neonatal septic group than the control group (p< 0. 001). The best cut off point of HMGB 1 to discriminate against the late-onset sepsis cases from the control newborn infants was > 68 ng/ml with a sensitivity of 97.5%, specificity of 95%, positive predictive value of 95.1% and negative predictive value of 97.4% with total accuracy of 0.99%. The values of HMGB1 were not affected by gestational age, birth weight, postnatal age or gender. There were no significant differences in mean values between survival and non-survival cases. The best cut off value to predict mortality in the late onset sepsis group was >167.8 ng/ml with a sensitivity of 60% and specificity of 54.29%. In conclusion, this study suggested that HMGB1 is a promising marker for diagnosis of late onset neonatal sepsis in full term infants, on the contrary HMGB1 could not predict mortality in neonatal septic patients.