| Summary: | Objective: This study aimed to investigate the association between high-mobility-group box 1 (HMGB1) and stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients. Methods: AIS patients were enrolled in two centers. The serum samples were collected within the first 24 h after admission, and HMGB1 levels were measured by enzyme-linked immunosorbent assay. Logistic regression models were used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of SAP for HMGB1 concentrations. Restricted cubic splines (RCS) were performed to explore the shapes of the association between HMGB1 concentrations and SAP. Results: From January 2022 to May 2022, a total of 420 AIS patients were enrolled. Ninety-six (22.9%) patients develop SAP. The levels of HMGB1 in the SAP group were higher than those in the non-SAP group (<i>p</i> < 0.001). Using the first quartile of HMGB1 group as a reference, patients in the fourth quartile of HMGB1 group had the highest likelihood of experiencing SAP in the unadjusted model (OR = 3.687; 95% CI: 1.851–7.344), age- and sex-adjusted model (OR = 3.511; 95% CI: 1.725–7.147), and multivariable-adjusted model (OR = 2.701; 95% CI: 1.045–6.981). HMGB1 was also independently associated with SAP as a continuous variable in the unadjusted model (OR = 1.132; 95% CI: 1.069–1.199), age- and sex-adjusted model (OR = 1.131; 95% CI: 1.066–1.200), and multivariable-adjusted model (OR = 1.096; 95% CI: 1.011–1.188). RCS showed a linear association between HMGB1 and SAP (<i>p</i> for linear trend = 0.008) Conclusions: HMGB1 might be able to act as a potential biomarker of SAP in AIS patients.
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