Early Sustained High-Level HMGB1 and Poor Outcomes After Neonatal Congenital Cardiac Surgery with Cardiopulmonary Bypass.

Activation of cell stress-related pathways and systemic inflammation during cardiopulmonary bypass (CPB) are observed in both neonatal and adult cardiac surgery. Surgical CPB stress can impact on the long-term cardiac and neurodevelopmental outcomes of patients undergoing congenital cardiac surgery. Elevated HMGB1, an inflammatory, danger-associated molecular pattern (DAMP) molecule, is associated with adverse outcomes after surgery. Here, we investigated its utility as a biomarker for adverse surgical and neurodevelopmental outcomes in CHD patients undergoing surgery with CPB. We enrolled 29 CHD patients undergoing neonatal cardiac surgery with CPB. Blood was collected before surgery, immediately after surgery, and at 24 and 48 h after CPB. HMBG1 serum levels were determined using an ELISA assay. Death from index surgery was tracked, and neurodevelopmental outcome was determined between 4 months and 24 months using the Bayley instrument (BSID-III). Serum HMGB1 level was significantly increased at 24 and 48 h after CPB. The peak HMGB1 level was higher in patients who died post-surgically. Higher HMGB1 levels were associated with Bayley scores below 1 standard deviation for expressive speech and motor, especially in the gross motor domain. These findings support the utility of HMGB1 as a biomarker for prognosticating postsurgical cardiac and neurodevelopmental outcomes in CHD patients.