Serum HMGB1 and sCD14 levels in neonates with jaundice: associations with disease severity and phototherapy efficacy.

OBJECTIVE

To investigate the associations of serum high-mobility group box-1 (HMGB1) and soluble cluster of differentiation antigen-14 (sCD14) with disease severity in neonatal jaundice, and to explore their relationship with phototherapy response.

METHODS

A total of 345 neonates with hyperbilirubinemia (February 2023-May 2025) and 100 healthy controls were prospectively enrolled. Patients were stratified into mild (n = 273) and severe (n = 72) groups based on total serum bilirubin (TSB). Serum HMGB1 and sCD14 levels were measured by enzyme-linked immunosorbent assay (ELISA) according to the manufacturers' instructions with strict quality control. After intermittent phototherapy, response was classified as effective (n = 294) or ineffective (n = 51). Correlations were assessed by Spearman's rank test. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS

Serum HMGB1 and sCD14 levels were elevated in jaundice patients versus controls, with further increases in severe versus mild hyperbilirubinemia (all p < 0.05). TSB, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) showed similar patterns. HMGB1 and sCD14 positively correlated with TSB, AST, and ALT (all p < 0.05). AST, ALT, HMGB1, and sCD14 differed significantly between the effective and ineffective phototherapy groups (all p < 0.05). Multivariable logistic regression identified AST, ALT, HMGB1, and sCD14 as independent predictors of treatment failure (all p < 0.05). ROC analysis revealed AUCs of 0.75 for HMGB1 alone and 0.75 for sCD14 alone, with their combination yielding a significantly higher AUC of 0.83.

CONCLUSIONS

In term neonates with non-hemolytic jaundice without severe comorbidities, serum HMGB1 and sCD14 levels are closely associated with disease severity and correlate with the efficacy of phototherapy. Their combined assessment may provide valuable reference indices for predicting phototherapy outcomes.