Abstract
Background and aimThe sensitivity and specificity of biomarkers and scoring systems used for predicting fatality of severe sepsis patients remain unsatisfactory. This study aimed to determine the prognostic value of circulating plasma DNA levels in severe septic patients presenting at the Emergency Department (ED).MethodsSixty-seven consecutive patients with severe sepsis and 33 controls were evaluated. Plasma DNA levels were estimated by real-time quantitative polymerase chain reaction assay using primers for the human β-hemoglobin and ND2 gene. The patients’ clinical and laboratory data on admission were analyzed.ResultsThe median plasma nuclear and mitochondria DNA levels for severe septic patients on admission were significantly higher than those of the controls. The mean plasma nuclear DNA level on admission correlated with lactate concentration (γ = 0.36, p = 0.003) and plasma mitochondrial DNA on admission (γ = 0.708, p < 0.001). Significant prognostic factors for fatality included mechanical ventilation within the first 24 hours (p = 0.013), mean sequential organ failure assessment (SOFA) score on admission (p = 0.04), serum lactate (p < 0.001), and both plasma nuclear and mitochondrial DNA on admission (p < 0.001). Plasma mitochondrial DNA was an independent predictor of fatality by stepwise logistic regression such that an increase by one ng/mL in level would increase fatality rate by 0.7%.ConclusionPlasma DNA has potential use for predicting outcome in septic patients arriving at the emergency room. Plasma mitochondrial DNA level on admission is a more powerful predictor than lactate concentration or SOFA scores on admission.
Highlights
Background and aimThe sensitivity and specificity of biomarkers and scoring systems used for predicting fatality of severe sepsis patients remain unsatisfactory
The median plasma nuclear and mitochondria DNA levels for severe sepsis patients on Emergency Department (ED) admission were significantly higher at 436 ng/ml and 149 ng/ml, respectively
The baseline characteristics of survivors and non-survivors in severe sepsis patients revealed that 65.7% (44/67) of patients had septic shock within 24-h of admission and 35.8% (24/67) had ventilator treatment within 24-h of admission (Table 3)
Summary
Background and aimThe sensitivity and specificity of biomarkers and scoring systems used for predicting fatality of severe sepsis patients remain unsatisfactory. This study aimed to determine the prognostic value of circulating plasma DNA levels in severe septic patients presenting at the Emergency Department (ED). Severe sepsis and septic shock remain a great challenge in critical care because of their common occurrence, high costs of care, and significant mortality. They are the major causes of death in patients admitted to the emergency department (ED) and intensive care units (ICU), Plasma DNA can be defined as DNA fragments that are detectable in extracellular fluid and are of two types: “free” DNA present in plasma (including DNA packed into nucleosomes of apoptotic cells) or DNA associated with circulating lymphocytes (considered a minor component) [2]. In critically ill conditions, organs responsible for elimination may be damaged as a consequence of ongoing systemic inflammation
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