Thalassaemia major and infectious risk: High Mobility Group Box‐1 represents a novel diagnostic and prognostic biomarker

Summary High mobility group box ‐1 ( HMGB 1) represents a common causal agent for various types of diseases, including infective pathologies. This study aimed to investigate the role of HMGB 1 in β‐thalassemia major ( TM ) by evaluating its diagnostic and prognostic role. Fifty‐one TM patients and 30 healthy subjects ( HS ) were enrolled. Receiver operating characteristics ( ROC ) analysis was employed to calculate the area under the curve ( AUC ) for HMGB 1 to determine the best cut‐off values capable of identifying infectious episodes. Adjusted risk estimates for infective events were calculated using univariate followed by multivariate Cox proportional hazard regression analysis. Serum HMGB 1 levels were higher in TM patients than in HS (14·6 ± 8·7 vs. 2·08 ± 0·9 ng/ml, P  < 0·0001). Patients who underwent splenectomy were characterized by lower levels of HMGB 1, when compared with patients with an intact spleen (10·2 ± 8 vs. 19·1 ± 7 ng/ml, P  = 0·004). ROC analyses revealed an AUC for serum HMGB 1 of 0·801, with a sensitivity and specificity of 92·3% and 68·2% to detect an infectious episode. Low HMGB 1 levels predicted high risk of infective events ( HR : 0·81; P  = 0·006). HMGB 1 represents a prognostic marker for TM patients and a predictive factor for infectious events.