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In this research, we measured HMGB1 (HMGB-1 ELISA kit IBL, Transatlantic LLC, Osceola, WI, USA). These benefits have been compared with IL-6, TNF-�� (both from R&D Systems Inc., Minneapolis, MN, USA), von Willebrand Factor (vWF) antigen (Asserachrom Roscovitine (Seliciclib,CYC202) vWF, Diagnostica Stago Inc., Parsippany, NJ, USA), angiopoietin-2 (Ang-2; Quantikine Ang-2 EIA, R&D Systems Inc., Minneapolis, MN, USA), soluble C5b-9 to assess the late phase of terminal complement activation (sC5b-9 EIA, Quidel Corp., San Diego, CA, USA), prothrombin fragments (PF 1+2; Enzygnost F1+2 EIA, Dade Behring, Germany), soluble thrombomodulin (TM; Asserachrom Thrombomodulin EIA, Diagnostica Stago Inc., Parsippany, NJ, USA), and plasminogen activator inhibitor 1 (PAI-1; Oxford Biochemicals, Oxford, MI, US).

protein C activity, tissue plasminogen ref 1 activator (t-PA), and D-Dimers have been measured with a Stago Compact (Diagnostica Stago Inc., Parsippany, NJ, USA), All measurements had been performed in accordance with the manufacturers' instructions.Data collection, outcome measuresData were collected prospectively on patient demographics, the injury time, mechanism (blunt or penetrating) and severity, pre-hospital fluid administration, time of arrival in the trauma room and admission vital signs. The Injury Severity Score (ISS) was used as a measure of the degree of tissue injury [21]. An arterial blood gas was drawn at the same time as the research sample as part of the standard management of major trauma patients. The base deficit was used as a measure of the degree of tissue hypoperfusion.

Admission base deficit is a clinically useful early marker of tissue hypoperfusion in trauma unfortunately patients and an admission base deficit greater than 6 mmol/l has previously been identified as being predictive of worse outcome in trauma patients [22,23].Outcome measuresPatients have been followed until hospital discharge or death. For mortality analysis, patients surviving to hospital discharge were assumed to still be alive. Secondary outcome measures were also recorded for 28-day ventilator-free days, acute lung injury (American-European consensus conference definition) [24] and acute renal injury (Acute Dialysis Quality Initiative consensus conference definition) [25] and blood transfusions required in the first 24 hours.Statistical analysisData analysis was performed by the investigators. Normal-quantile plots had been used to test for normal distribution.

Relations between quartile of HMGB1 and continuous variables were tested with the Kruskall-Wallis test followed by a non-parametric test for trend. Two-group analysis was performed using the Wilcoxon rank-sum method. Correlation was assessed by Spearman correlation coefficients. Logistic regression was used to examine the relationship between mortality and HMGB1 levels. A P �� 0.05 was chosen to represent statistical significance.