Plasma levels of mitochondrial DNA in patients presenting to the emergency department with sepsis.
Plasma levels of mitochondrial DNA in patients presenting to the emergency department with sepsis.
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DOI：
10.1097/shk.0b013e318266a169
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Jones AE
中科院分区：
文献类型：
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作者：
Puskarich MA;Shapiro NI;Trzeciak S;Kline JA;Jones AE
据报道，创伤患者血浆线粒体DNA（mtDNA）水平升高，可能有助于全身免疫反应。我们试图确定血浆线粒体DNA水平在急诊科（艾德）患者和非败血症，并评估其与疾病的严重程度。在三家大型城市三级医疗急诊室就诊的患者中开展的前瞻性观察性研究。患者被纳入三个队列之一：1）脓毒症，定义为疑似感染和两个或更多SIRS标准，无低血压; 2）脓毒性休克，定义为脓毒症加低血压，尽管有足够的液体挑战;和3）对照，定义为非感染艾德患者，无SIRS/低血压。采用实时定量PCR技术检测血浆中三种mtDNA的水平。比较三个队列之间的mtDNA水平，并使用线性回归评估败血症患者的mtDNA、IL-6、IL-10和序贯器官衰竭评估（SOFA）评分之间的相关性。我们招募了93名患者：24名对照，29名脓毒症患者和40名脓毒性休克患者。正如预期，各类别的合并症和SOFA评分均增加。我们发现三组之间的线粒体DNA水平没有差异（p = 0.14-0.30）。在脓毒症患者中，我们发现线粒体DNA水平与SOFA评分之间存在微小但显著的负相关性，与细胞色素B的相关性最明显（p=0.03）。我们发现对照组和脓毒症患者之间的mtDNA水平没有差异。mtDNA水平与器官功能障碍呈负相关，表明血浆mtDNA对脓毒症的病理生理学无显著影响。
Elevated levels of plasma mitochondrial DNA (mtDNA) have been reported in trauma patients, and may contribute to the systemic immune response. We sought to determine the plasma levels of mtDNA in emergency department (ED) patients with and without sepsis and evaluate their association with severity of illness. Prospective observational study of patients presenting to one of three large, urban, tertiary care EDs. Patients were enrolled into one of three cohorts: 1) sepsis defined as suspected infection and two or more SIRS criteria without hypotension; 2) septic shock defined as sepsis plus hypotension despite an adequate fluid challenge; and 3) control defined as non-infected ED patients without SIRS/hypotension. Plasma levels of three mtDNAs were measured using real-time quantitative PCR. Levels of mtDNAs were compared between the three cohorts and linear regression was used to assess the association between mtDNAs, IL-6, IL-10, and sequential organ failure assessment (SOFA) scores in patients with sepsis. We enrolled 93 patients: 24 controls, 29 with sepsis, and 40 with septic shock. As expected, co-morbidities and SOFA score increased across categories. We found no difference in mtDNA levels between the three groups (p = 0.14-0.30). Among patients with sepsis, we found a small but significant negative association between mtDNA level and SOFA score, most clearly with cytochrome b (p=0.03). We found no difference in mtDNA levels between controls and patients with sepsis. mtDNA levels were negatively associated with organ dysfunction, suggesting that plasma mtDNA does not significantly contribute to the pathophysiology of sepsis.