Cell-free plasma DNA as a predictor of outcome in severe sepsis and septic shock
Cell-free plasma DNA as a predictor of outcome in severe sepsis and septic shock
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DOI：
10.1373/clinchem.2007.101030
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发表时间：
2008-06-01
影响因子：
9.3
通讯作者：
Pulkki, Kari
中科院分区：
文献类型：
--
作者：
Saukkonen, Katri;Lakkisto, Paivi;Pulkki, Kari
背景：在脓毒症和危重病患者的血浆中发现游离DNA浓度增加。我们调查了血浆DNA的价值重症监护室（ICU）和医院死亡率的预测和其与严重脓毒症患者的器官功能障碍和疾病严重程度的关系。方法：我们研究了255例严重脓毒症或脓毒性休克患者。我们在研究纳入当天和72小时后采集血样，并通过实时定量PCR测定β-珠蛋白基因的游离血浆DNA。ICU死亡者入院时血浆游离DNA浓度高于存活者（中位数15 904 vs 7522基因组当量[GE]/mL，P < 0.001）和72 h后（中位数15 176 GE/mL vs 6758 GE/mL，P = 0.004）。血浆DNA值也高于医院的非幸存者比幸存者（P = 0.008至0.009）。通过ROC分析，血浆DNA浓度对ICU死亡率具有中等区分力（AUC 0.70-0.71）。在多元回归分析中，第一天血浆DNA是ICU死亡率的独立预测因子（P = 0.005），但不是医院死亡率的独立预测因子。最大乳酸值和序贯器官衰竭评估评分独立相关的第一粘土血浆DNAinlinearregression analysis.CONCLUSIONS：无细胞血浆DNA浓度显着高于ICU和医院非幸存者比幸存者，并显示了一个温和的鉴别力ICU死亡率。血浆DNA浓度是ICU死亡率的独立预测因子，但不是医院死亡率的独立预测因子，这一发现降低了其在严重脓毒症和脓毒性休克中的临床价值。(c)2008年美国临床化学协会。
BACKGROUND: Increased concentrations of cell-free DNA have been found in plasma of septic and critically ill patients. We investigated the value of plasma DNA for the prediction of intensive care unit (ICU) and hospital mortality and its association with the degree of organ dysfunction and disease severity in patients with severe sepsis.METHODS: We studied 255 patients with severe sepsis or septic shock. We obtained blood samples on the day Of study inclusion and 72 h later and measured cell-free plasma DNA by real-time quantitative PCR assay for the beta-globin gene.RESULTS: Cell-free plasma DNA concentrations were higher at admission in ICU nonsurvivors than in survivors (median 15 904 vs 7522 genome equivalents [GE]/mL, P < 0.001) and 72 h later (median 15 176 GE/mL vs 6758 GE/mL, P = 0.004). Plasma DNA values were also higher in hospital nonsurvivors than in survivors (P = 0.008 to 0.009). By ROC analysis, plasma DNA concentrations had moderate discriminative power for ICU mortality (AUC 0.70-0.71). In multiple regression analysis, first-day plasma DNA was an independent predictor for ICU mortality (P = 0.005) but not for hospital mortality. Maximum lactate value and Sequential Organ Failure Assessment score correlated independently with the first-clay plasma DNA in linear regression analysis.CONCLUSIONS: Cell-free plasma DNA concentrations were significantly higher in ICU and hospital nonsurvivors than in survivors and showed a moderate discriminative power regarding ICU mortality. Plasma DNA concentration was an independent predictor for ICU mortality, but not for hospital mortality, a finding that decreases its clinical value in severe sepsis and septic shock. (c) 2008 American Association for Clinical Chemistry.