Plasma high-mobility group box 1 as an indicator of surgical stress

Purpose: High-mobility group box 1 (HMGB-1) is a late-phase cytokine, which is released extracellularly in response to systemic inflammation caused by infection, shock, or trauma. We examined the plasma levels of HMGB-1 to clarify its role in surgical stress. Methods: The subjects of this study were 37 patients who underwent elective general surgery. We measured plasma concentrations of HMGB-1 over time using a quantitative enzyme-linked immunosorbent assay. We then analyzed the relationships between the change in HMGB-1 concentration and perioperative factors, including postoperative complications. Statistical analyses were performed using two-way repeated-measures analysis of variance. Results: The HMGB-1 level was higher on postoperative day 3 in patients with a prolonged operative time or large intraoperative blood loss (P = 0.048 and P = 0.041, respectively). The HMGB-1 level also remained high over time in patients with postoperative complications (P = 0.037). Conclusions: These results show that the plasma HMGB-1 level is related to surgical stress such as operative time and blood loss. The level remained high over time in patients with postoperative complication, suggesting progression of the complication.