Abstract
BackgroundCell-free DNA has been proposed as a means of predicting complications among severely injured patients. The purpose of this systematic review was to assess whether cell-free DNA was useful as a prognostic biomarker for outcomes in trauma patients in the intensive care unit.MethodsWe searched Pubmed, Embase, Scopus and the Cochrane Central Register for Controlled Trials and reference lists of relevant articles for studies that assessed the prognostic value of cell-free DNA detection in trauma patients in the intensive care unit. Outcomes of interest included survival, posttraumatic complications and severity of trauma. Due to considerable heterogeneity between the included studies, a checklist was formed to assess quality of cell-free DNA measurement.ResultsA total of 14 observational studies, including 904 patients, were eligible for analysis. Ten studies were designed as prospective cohort studies; three studies included selected patients from a cohort while one study was of a retrospective design. We found a significant correlation between higher values of cell-free DNA and higher mortality. This significant correlation was evident as early as on intensive care unit admission. Likewise, cell-free DNA predicted the severity of trauma and posttraumatic complications in a majority of patients.ConclusionThe amount of cell-free DNA can function as a prognostic tool for mortality and to a lesser extent severity of trauma and posttraumatic complications. Standardizing cell-free DNA measurement is paramount to ensure further research in cell-free DNA as a prognostic tool.
Highlights
Cell-free DNA has been proposed as a means of predicting complications among severely injured patients
Of the remaining 18 studies, six studies were excluded for the following reason: four studies were based on nontrauma patients [23,24,25,26] and two studies included both intensive care unit (ICU) and nonICU patients [27, 28]
In a study of 56 patients, no correlation was found between severity of trauma scored with Injury Severity Score (ISS) and levels of cell-free DNA (cfDNA) [37]; four other studies found a significant correlation between cfDNA and ISS score
Summary
Cell-free DNA has been proposed as a means of predicting complications among severely injured patients. The purpose of this systematic review was to assess whether cell-free DNA was useful as a prognostic biomarker for outcomes in trauma patients in the intensive care unit. In recent years cell-free DNA (cfDNA) has become increasingly used as a clinical and noninvasive biomarker in the fields of cancer [1,2,3], pre-natal diagnostics [4], organ transplantation [5], and in several emergency conditions [6,7,8]. In patients admitted to an intensive care unit (ICU) as a result of trauma, cfDNA has received increasing attention under the hypothesis that cfDNA originates from cell death [12, 13] and could correlate with the severity of trauma with prognostic and predictive abilities.
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