AimThe aim of the current study is to assess the mortality prediction accuracy of circulating cell-free DNA (CFD) level at admission measured by a new simplified method.Materials and MethodsCFD levels were measured by a direct fluorescence assay in severe sepsis patients on intensive care unit (ICU) admission. In-hospital and/or twenty eight day all-cause mortality was the primary outcome.ResultsOut of 108 patients with median APACHE II of 20, 32.4% have died in hospital/or at 28-day. CFD levels were higher in decedents: median 3469.0 vs. 1659 ng/ml, p<0.001. In multivariable model APACHE II score and CFD (quartiles) were significantly associated with the mortality: odds ratio of 1.05, p = 0.049 and 2.57, p<0.001 per quartile respectively. C-statistics for the models was 0.79 for CFD and 0.68 for APACHE II. Integrated discrimination improvement (IDI) analyses showed that CFD and CFD+APACHE II score models had better discriminatory ability than APACHE II score alone.ConclusionsCFD level assessed by a new, simple fluorometric-assay is an accurate predictor of acute mortality among ICU patients with severe sepsis. Comparison of CFD to APACHE II score and Procalcitonin (PCT), suggests that CFD has the potential to improve clinical decision making.

Overall seroconversion rate in our cohort was higher than in previous reports in the literature, possibly due to a low disease activity state in the majority of participants. Third-generation hepatitis B virus vaccines showed no apparent advantage over standard of care vaccine in this patient group.

Dissipation tends to wash out dynamical features observed at early evolution times. In this paper we analyze a resonant single-atom two-photon quantum optical amplifier both dynamically and thermodynamically. A detailed thermodynamic balance shows that the non-linear amplifier is thermodynamically equivalent to the linear amplifier discussed in Ref. [1]. However, by calculating the Wigner quasi-probability distribution for various initial field states, we show that unique quantum features in optical phase space, absent from the linear amplifier, are maintained for extended times. These features are related to the discrete nature of the two-photon matter-field interaction, and fingerprint the initial field state at thermodynamic times.

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