High mobility group box 1 as a potential diagnostic and prognostic biomarker in Egyptian cirrhotic patients with infection

Abstract Background Infections in patients with cirrhosis pose a major clinical challenge, often aggravating liver dysfunction and increasing the risk of intensive care unit (ICU) admission and mortality. Conventional inflammatory biomarkers, such as C-reactive protein (CRP), are useful for early infection detection; however, their rapid decline limits their value for ongoing clinical assessment. Aim To evaluate the role of high mobility group box 1 (HMGB1) as a potential biomarker for diagnosing infections and predicting the need for intensive care in patients with cirrhosis. Materials and methods This study included 88 participants classified into three groups: 34 cirrhotic patients with infection (Group A), 30 cirrhotic patients without infection (Group B), and 24 healthy controls (Group C). Clinical and laboratory parameters were assessed, and serum HMGB1 levels were measured and compared among the three groups. Results HMGB1 levels showed a strong positive correlation with neutrophil counts and CRP levels, but were not associated with liver disease severity, as assessed by the Model for End-Stage Liver Disease–Sodium (MELD-Na) and Child–Pugh scores. HMGB1 demonstrated a sensitivity of 90.9% and a specificity of 95.65% for distinguishing patients requiring ICU admission from those suitable for ward management at a cut-off value of > 3.24 µg/L. These findings are exploratory and require validation in larger cohorts. Conclusion HMGB1 may serve as a promising biomarker for diagnosing infection and predicting intensive care requirements in patients with cirrhosis. Nevertheless, larger multicenter studies are warranted to confirm its clinical utility before routine implementation in diagnostic and prognostic protocols.