Role of early cell-free DNA levels decrease as a predictive marker of fatal outcome after severe traumatic brain injury
Role of early cell-free DNA levels decrease as a predictive marker of fatal outcome after severe traumatic brain injury
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DOI：
10.1016/j.cca.2012.08.001
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发表时间：
2012-12-24
影响因子：
5
通讯作者：
Rubio, Amalia
中科院分区：
文献类型：
--
作者：
Macher, Hada;Egea-Guerrero, Juan J.;Rubio, Amalia
简介：创伤后循环游离 DNA 水平升高。自创伤后最初几个小时起，这种增加就更高，可能与主要结局有关。需要针对高风险患者的敏感且可靠的生物标志物来识别这些患者以启动早期干预。这样，循环DNA可能是严重TBI后的一个可能的生物标志物。材料和方法：我们通过实时PCR研究了严重创伤性脑损伤后以及重症监护病房(ICU)中接下来的96小时内的DNA血浆浓度。该研究纳入了 65 名患有严重 TBI 的患者。结果：与自愿对照样本相比，患者样本中的游离 DNA 水平显着升高。接下来的四天后，我们观察到前 24 小时内下降了 51%，48 小时后下降了 71%。根据主要结果（幸存者/非幸存者）对 TBI 人群进行分层，并计算前 48 小时内 DNA 水平下降率。与非幸存者相比，从 0 小时到 24 小时，幸存者的减少幅度更大。建立了 1.95 比率的临界点，用于检测 TBI 后无法存活的最高比例患者，其敏感性为 70%，特异性为 66%。结论：总而言之，我们表明严重的 TBI 与 cf-DNA 水平升高相关，我们建议前 24 小时内 cf-DNA 的下降可以预测患者的预后。 (C) 2012 Elsevier B.V. 保留所有权利。
Introduction: Circulating cell-free DNA levels are increased after trauma injury. This increase is higher since the first hours after trauma and may be related with primary outcome. A sensitive and reliable biomarker for patients at higher risk is needed to identify these patients to initiate early intervention. In this way, circulating DNA may be a possible biological marker after severe TBI.Materials and methods: We investigated DNA plasma concentrations after severe traumatic brain injury and during the next 96 h in the Intensive Care Unit (ICU) by real time PCR. 65 patients suffering severe TBI were included in the study.Results: Cell-free DNA levels were considerably higher in patients samples compared with voluntary control ones. After the following four days we observed a 51% decrease during the first 24 h and a 71% fall from 48 h. TBI population was stratified for the primary outcome (survivors/non-survivor) and DNA levels decrease ratio was calculated for the first 48 h. A higher decrease in the survivors from 0 h to 24 h compared with the non-survivors was found. A cut-off point of 1.95 ratio was established for the detection of the highest proportions of patients after the TBI that will not survive after the injury with a sensitivity of 70% and specificity of 66%.Conclusions: In summary we showed that severe TBI is associated with elevated cf-DNA levels and we propose that cf-DNA decrease during the first 24 h may predict patient outcome. (C) 2012 Elsevier B.V. All rights reserved.