Circulating cell-free DNA levels correlate with postresuscitation survival rates in out-of-hospital cardiac arrest patients
Circulating cell-free DNA levels correlate with postresuscitation survival rates in out-of-hospital cardiac arrest patients
复制标题
DOI：
10.1016/j.resuscitation.2011.07.039
复制
发表时间：
2012-02-01
期刊：
影响因子：
6.5
通讯作者：
Chen, Wen-Jone
中科院分区：
文献类型：
--
作者：
Huang, Chien-Hua;Tsai, Min-Shan;Chen, Wen-Jone
早期预测预后对心脏骤停患者有帮助。血浆无细胞DNA在细胞死亡后迅速增加，是一种新的预测危重病人预后的生物标志物。血浆游离DNA水平的变化及其对心脏骤停患者早期预后的作用尚不清楚。我们前瞻性地招募了持续自主循环恢复的院外心脏骤停(UchA)成人患者。按照Utstein的建议记录复苏变量。采用实时荧光定量聚合酶链式反应检测血浆游离DNA浓度。共有42名患者参加了这项研究。死亡组心脏骤停后2小时内血浆游离DNA水平高于存活至出院组(中位数分别为1659.9和1121.6克/毫升，经非参数检验，p=0.003)。72h血浆游离DNA水平两组间无明显差异。经ROC曲线分析(曲线下面积0.752，p=0.010)，预测患者存活至出院的最佳临界值为1170g.e.e.m L。多因素Logistic回归分析显示，血浆游离DNA水平高于1170g·e·g·g·L-1是住院死亡率的独立预测因子(调整后优势比为12·35p=0.023)，并与较高的90天死亡率相关(经对数等级检验p=0.021)。综上所述，血浆游离DNA水平在心脏骤停后早期升高，并可作为早期预后因素。(C)2011爱思唯尔爱尔兰有限公司。保留所有权利。
Early prediction of prognosis is helpful in cardiac arrest patients. Plasma cell-free DNA, which increases rapidly after cell death, is a novel biomarker for the prognosis of critical ill patients. Changes in the plasma cell-free DNA level and its role for the early prognosis of cardiac arrest patients remain unclear. We prospectively enrolled adult out-of-hospital cardiac arrest (OHCA) patients with sustained return of spontaneous circulation. The resuscitation variables were recorded following the Utstein recommendation. The plasma cell-free DNA concentration was determined by quantitative real-time polymerase chain reaction assay of beta-globin gene. A total of 42 patients were enrolled for the study. The plasma cell-free DNA level within 2 h after cardiac arrest was higher in the non-survival group than the survival-to-discharge group (median level 1659.9 g. e./mL vs. 1121.6 g. e./mL, p=0.003 by non-parametric test). The plasma cell-free DNA level at 72 h became no difference between these two groups. The optimal cutoff value of plasma cell-free DNA for predicting survival-to-discharge was 1170 g. e./mL by ROC curve analysis (area under curve 0.752, p=0.010). A plasma cell-free DNA level higher than 1170 g. e./mL and was an independent predictor for in-hospital mortality by multiple logistic regression analysis (adjusted odds ratio of 12.35, p=0.023) and was also associated with higher 90 day mortality (p=0.021 by log-rank test). In conclusion, the plasma cell-free DNA level increases during the early post-cardiac arrest phase and can be an early prognostic factor for OHCA patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved.