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-day 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.

译文

背景:在脓毒症和危重病人的血浆中发现无细胞DNA的浓度增加。我们调查了血浆DNA在重症败血症患者中预测重症监护病房(ICU)和医院死亡率及其与器官功能障碍程度和疾病严重程度的关系。
方法:我们研究了255例严重脓毒症或败血性休克患者。我们在纳入研究当日和72小时后获得了血液样本,并通过实时定量PCR检测β-珠蛋白基因来测量无细胞血浆DNA。
结果:ICU非幸存者入院时的无细胞血浆DNA浓度高于幸存者(中位数15 904 vs 7522基因组当量[GE] / mL,P <0.001)和72小时后(中位数15 176 GE / mL vs 6758 GE) /mL,P=0.004)。住院非幸存者的血浆DNA值也高于幸存者(P = 0.008至0.009)。通过ROC分析,血浆DNA浓度对ICU死亡率具有中等判别力(AUC 0.70-0.71)。在多元回归分析中,首日血浆DNA是ICU死亡率的独立预测因子(P = 0.005),而不是医院死亡率的预测因子。在线性回归分析中,最大乳酸值和顺序器官衰竭评估得分与第一天血浆DNA独立相关。
结论:ICU和住院非幸存者的无细胞血浆DNA浓度明显高于幸存者,并且在ICU死亡率方面具有中等判别力。血浆DNA浓度是ICU死亡率的独立预测因素,但不是医院死亡率的独立预测因素,这一发现降低了其在严重败血症和败血性休克中的临床价值。

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