Objective To investigate the expression and significance of heat shock protein 70 (HSP70), apoptosis-associated speck-like protein (ASC), and vitamin D in children with febrile seizures (FS).

Methods A total of 200 children with FS admitted to our hospital from June 2022 to December 2023 were selected as FS group, including 158 cases of simple FS and 42 cases of complex FS. Another 200 febrile children without FS were selected as fever group, and 50 healthy children were selected as control group. The differences in HSP70, ASC mRNA, and vitamin D expression among the three groups were compared. The differences in HSP70, ASC mRNA, and vitamin D expression at different time points in children with different types of FS were compared. The influencing factors and predictive value of complex FS were analyzed.

Results At admission, the expression levels of HSP70 and ASC mRNA gradually decreased, while the vitamin D levels gradually increased in the FS group, fever group, and control group, with statistically significant between-group differences (P < 0.01). One hour after admission, the levels of HSP70 and ASC mRNA in both the complex FS group and the simple FS group were lower than those at admission (P < 0.01). The levels of HSP70 and ASC mRNA in the complex FS group at admission and 1 hour after admission were higher than those in the simple FS group, while the vitamin D level was lower (P < 0.01). Multivariate Logistic regression analysis showed that elevated HSP70 and ASC mRNA levels at admission were independent risk factors for complex FS (P < 0.001), while elevated vitamin D level was an independent protective factor for complex FS (P < 0.001). The area under the curve (AUC) for HSP70, ASC mRNA, and vitamin D in assessing complex FS were 0.785 (95%CI, 0.721 to 0.840), 0.766 (95%CI, 0.701 to 0.823), and 0.760 (95%CI, 0.695 to 0.817), respectively. The combined AUC of HSP70, ASC mRNA, and vitamin D for assessing complex FS was 0.915, with a sensitivity of 90.48% and a specificity of 81.65%. The AUC of combined assessment of complex FS by various factors was greater than that of HSP70, ASC mRNA, and vitamin D alone (Z=2.743, 2.749, 3.086, P=0.006, 0.006, 0.002).

Conclusion The levels of HSP70 and ASC mRNA are elevated, while the vitamin D level is reduced in children with complex and simple FS. The combined assessment of HSP70, ASC mRNA, and vitamin D at admission has high value in assessing complex FS.