Cell‐Free Plasma DNA as a Prognostic Marker in Intensive Treatment Unit Patients

Abstract

Recent evidence suggests that cell-free plasma DNA has potential use as a prognostic marker in many clinical settings. The aim of the present study was to evaluate the prognostic role of cell-free plasma DNA in the prediction of clinical outcome in intensive treatment unit (ITU) patients. Cell-free plasma DNA was measured by real-time polymerase chain reaction assay for the beta-globin gene and SOFA score, APACHE II score, CRP concentrations, and clinical outcome (duration of stay, ventilation time, and mortality) were noted in 94 patients on admission to the ITU. The median plasma DNA concentration in ITU patients was 5493 GE/mL and this was significantly (P <0.001) higher than the DNA concentration in healthy subjects (1970 GE/mL). DNA concentration demonstrated a significant correlation with serum C-reactive protein (CRP) (r = 0.363) concentration and Sepsis-related Organ Failure Assessment (SOFA) (r = 0.360) score (P <0.001 for both by Pearson correlation) but not with Acute Physiology And Chronic Health Evaluation (APACHE II) score. Patients on ventilation had significantly higher DNA concentrations compared to nonventilated patients (7362 GE/mL versus 4479 GE/mL; P = 0.004). The median DNA concentration in nonsurvivors was 9148 GE/mL, and this was 2.3-fold greater than that in survivors (3921 GE/ml, P <0.001). ROC analysis of the data indicated a sensitivity of 85% and a specificity of 80% when DNA concentration of 6109 GE/mL was taken as a predictor of death. The data suggest that cell-free plasma DNA concentration is potentially useful as a prognostic marker in ITU patients.

Cell-Free Plasma DNA as a Predictor of Outcome in Severe Sepsis and Septic Shock

“…Our study was the first to demonstrate that rising or falling concentrations of plasma DNA were not related to the outcomes of patients with severe sepsis. Our results showing that nonsurvivors had higher plasma DNA concentrations than survivors are in agreement with earlier studies performed in intensive care patients (17)(18)(19). Rhodes et al (18 ) demonstrated in a critically ill patient population that patients who developed severe sepsis or septic shock had higher plasma DNA concentrations.…”

“…Furthermore, increased plasma levels of nucleosomes, in which fragmented DNA is packed during apoptosis, have been found in patients with severe sepsis and septic shock (16 ). Preliminary data from ICU patients suggest that admission plasma DNA concentrations may be higher in nonsurvivors than in survivors (17,18 ). We have recently shown that the maximum cell-free plasma DNA concentration in the first days of intensive care is independently associated with hospital mortality in critically ill patients (19 ).…”

Changes in cell free DNA during a college soccer season

“…A correlation between cf-DNA and CRP (r = 0.36, P < 0.001) has also been demonstrated in intensive care unit patients. 41 Other research has found no correlation between cf-DNA and CRP. 42,43 Previous research in team sports such as soccer and rugby has shown that CRP and CK may not peak until 24-48 hours post competition, and may remain significantly elevated above baseline for several days.…”

Cell free DNA as a marker of training status in weightlifters

“…A correlation between cf-DNA and CRP has been reported [12,25]. This correlation between cf-DNA and CRP suggests that cf-DNA may be a valuable indicator of inflammation.…”

“…Hydration was measured via urinary specific gravity (USG) with a PAL-10S Refractometer (Atago, Tokyo, Japan). A USG ≥ 1.020 signifies dehydration (25), but no subject USG measurements were ≥ 1.020 at any of the 6 measurement times. Biochemical markers are quantified as concentrations in plasma or serum as well as percent change (%∆).…”