Plasma cell-free DNA and qSOFA score predict 7-day mortality in 481 emergency department bacteraemia patients
Plasma cell-free DNA and qSOFA score predict 7-day mortality in 481 emergency department bacteraemia patients
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DOI：
10.1111/joim.12766
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发表时间：
2018-10-01
影响因子：
11.1
通讯作者：
Aittoniemi, J.
中科院分区：
文献类型：
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作者：
Rannikko, J.;Seiskari, T.;Aittoniemi, J.
背景一些研究表明，快速序贯器官衰竭评估（qSOFA）评分和无细胞DNA（cfDNA）都有可能用作感染患者的预后标志物。我们研究了这两个标志物单独和联合使用，以确定那些急诊科（艾德）患者的死亡风险最高。对481例培养阳性的血流感染病例在进入艾德后0至4天的血浆cfDNA水平进行了研究。根据脓毒症-3定义回顾性评价qSOFA评分。主要结局为第7天死亡。在481例病例中，有134例（28%）在第0天，非存活者的CfDNA显著高于存活者（2.02 μ g mL（-1）vs. 1.35 μ g mL（-1），P1.69 μ g mL（-1）），458例病例中有128例（28%）的qSOFA评分为2。高cfDNA和qSOFA评分>= 2在预测第7天死亡方面分别具有70%和77%的灵敏度以及76%和76%的特异性。与cfDNA和qSOFA评分低的患者相比，cfDNA单独高的比值比（OR）为7.7（95% CI 3.9-15.3），qSOFA评分≥ 2的OR为11.6（5.5-24.3），但其组合在预测第7天死亡方面的OR为20.3（10.0-41.4
Background. A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell-free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death.Methods. Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture-positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis-3 definitions. The primary outcome was death by day 7.Results. CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 mu g mL(-1) vs. 1.35 mu g mL(-1), P1.69 mu g mL(-1)) in 134 (28%) of 481 cases, and the qSOFA score was 2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score >= 2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. High cfDNA alone had odds ratio (OR) of 7.7 (95% CI 3.9-15.3) and qSOFA score >= 2 OR of 11.6 (5.5-24.3), but their combination had OR of 20.3 (10.0-41.4) in predicting death by day 7 when compared with those with low cfDNA and qSOFA score