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Plasma HMGB1 levels and physical performance in ICU survivors
Author(s) -
Brück Emily,
SvenssonRaskh Anna,
Larsson Jacob W.,
Caravaca April S.,
Gallina Alessandro L.,
Eberhardson Michael,
Sackey Peter V.,
Olofsson Peder S.
Publication year - 2021
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13815
Subject(s) - medicine , intensive care unit , prospective cohort study , grip strength , physical therapy
Purpose Physical impairment after critical illness is recognized as a part of the post‐intensive care syndrome (PICS). About one third of intensive care unit (ICU) survivors suffer from long‐term physical disability, yet the underlying pathophysiological mechanisms remain poorly understood. The pro‐inflammatory alarmin, high mobility group box 1 (HMGB1), promotes muscle dysfunction in experimental models, and HMGB1 stays elevated in some patients after ICU discharge. Accordingly, we investigated the relationship between HMGB1 plasma levels and physical performance in ICU survivors. Methods Prospective cohort study of 100 ICU survivors from the general ICU at the Karolinska University Hospital, Sweden. Patients returned for follow up at 3 (58 patients) and 6 months (51 patients) after ICU discharge. Blood samples were collected, and a 6‐minute walk test (6‐MWT), a handgrip‐strength test (HST), and a timed‐stands test (TST) were performed. Results Compared to reference values of the different physical tests, 16% of patients underperformed at all tests at 3 months and 12% at 6 months. All test results, except hand‐grip strength left, improved significantly over the follow‐up period ( P < .05). There was no significant association between plasma HMGB1 levels at 3 and 6 months and scores on the three tests (6‐MWT, TST, and HST) ( P = .50‐0.69). Conclusion In this follow‐up study of ICU survivors, we found no significant association between plasma HMGB1 levels and physical performance. Additional follow‐up studies of HMGB1 plasma levels and muscle function in ICU survivors are still warranted. Editorial Comment HMGB‐1, a marker of cell damage and activation, is known to increase in ICU patients. In study participants at 3‐ to 6‐month post‐ICU stay, HMGB‐1 levels were still elevated, although no association to the primary outcome, physical performance, was found. Mechanisms for failure to recover physical performance post‐ICU remain unclear, and investigations into cause of post‐intensive care syndrome need to continue. Trial registrations ClinicalTrials.gov identifier NCT02914756.