Association between high-mobility group box 1 levels and febrile seizures in children: a systematic review and meta-analysis

Abstract

The relationship between High-mobility group box 1 (HMGB1) and febrile seizures (FS) in children remains unclear. This study aimed to apply meta-analysis to reveal the correlation between HMGB1 levels and FS in children. Databases including PubMed, EMBASE, Web of science, Cochrane library, CNKI, SinoMed and WanFangData were searched for relevant studies. Pooled standard mean deviation and 95% confidence interval were calculated as effect size since the random-effects model was used when I² > 50%. Meanwhile, between-study heterogeneity was determined by performing subgroup and sensitivity analyses. A total of 9 studies were finally included. Meta-analysis showed that the children with FS had significantly higher HMGB1 levels compared with healthy children and children with fever but no seizures (P<0.05). Additionally, subgroup analysis showed that the HMGB1 level in children with complex FS was higher than those with simple FS (P<0.05), and children with duration >15 min were higher than those with duration ≤15min (P<0.05). There were no statistical differences between children with or without a family history of FS (P>0.05). Finally, children with FS who converted to epilepsy exhibited higher HMGB1 levels than those who did not convert to epilepsy (P<0.05). The level of HMGB1 may be implicated in the prolongation, recurrence and development of FS in children. Thus, it was necessary to evaluate the precise concentrations of HMGB1 in FS patients and to further determine the various activities of HMGB1 during FS by well-designed, large-scale, and case-controlled trials.

Figure 1

Flowchart of the literature search and study selection.

Figure 2

Forest plots of serum HMGB1 levels in FS group, FN group and healthy controls.

Figure 3

Forest plots of CSF HMGB1 levels in FS group, FN group and healthy controls.

Figure 4

Sensitivity Analysis of all included studies ((A) FN group and healthy controls; (B) FS group and healthy controls; (C) FS group and FN group).

Figure 5

Publication bias tests of all included studies ((A,B) a funnel of Begg’s test and Egger’s test of FN group and healthy controls: (C,D) a funnel of Begg’s test and Egger’s test of FS group and healthy controls; (E,F) a funnel of Begg’s test and Egger’s test of FS group and FN group.