Prognostic Use of Circulating Plasma Nucleic Acid Concentrations in Patients with Acute Stroke

Abstract

Background: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments. Methods: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients' plasma was analyzed for the ␤-globin gene with a fluorescent-based PCR test. The primary outcome measures were in-hospital and 6-month mortality and morbidity using the post-stroke modified Rankin Score. Results: Among the 88 consecutive patients recruited to the study, 70 (80%) had ischemic stroke, 11 (13%) had intracerebral hemorrhage, and 7 (8%) had transient ischemic attacks. Median plasma DNA concentrations taken within 3 h of symptom onset were higher in patients who died compared with those who survived at discharge (6205 vs 1334 kilogenome-equivalents/L; P ‫؍‬ 0.03). Among patients with NIH Stroke Scale scores >8, median plasma DNA concentrations were higher in patients who died compared with those who survived to 6 months (2273 vs 968 kilogenome-equivalents/L; P ‫؍‬ 0.002). Plasma DNA concentrations correlated with the volume of cerebral hematoma (r ‫؍‬ 0.66; P ‫؍‬ 0.03). Plasma DNA concentrations >1400 kilogenome-equivalents/L had a sensitivity of 100% and a specificity of 74.4% for predicting hospital mortality after stroke, and the area under the ROC curve was 0.89 (95% confidence interval, 0.80 -0.94). The adjusted odds ratio for plasma DNA concentrations predicting 6-month mortality was

Prognostic value of cell-free DNA in plasma of out-of-hospital cardiac arrest survivors at ICU admission and 24h post-admission

“…The anoxic and post-anoxic injuries occur in all organs and cell-free DNA originates from all tissues, unlike some other conditions in which circulating DNA was associated with outcome, such as stroke [9], myocardial infarction [10] and acute pancreatitis [13]. In the post-arrest patients, the cerebral and myocardial damage determine the patients' outcome and although circulating DNA originates from all tissues, its quantity is still in association with mortality.…”

“…Cell-free plasma DNA has been investigated as a diagnostic tool in various conditions [4], mainly chronic: autoimmune diseases [5] and cancer [6,7], but it was also investigated and associated with outcome in several acute conditions such as trauma [8], stroke [9], myocardial infarction [10], sepsis [11] and acute pancreatitis [12,13].…”

Neueste technologische Entwicklungen für die Analyse von zirkulierender Tumor-DNA

“…Die Tatsache, dass zellfreie DNA (cfDNA) auch bei gesunden Individuen zu finden ist, spricht dafür, dass es sich bei der Freisetzung eigentlich um einen physiologischen Prozess handelt. Studien weisen aber darauf hin, dass man in bestimmten pathologischen Konditionen wie dem systemischen Lupus erythematodes (SLE), der rheumatoiden Arthritis und speziell bei Tumorpatienten erhöhte Mengen an zellfreier DNA findet [3,[6][7][8][9][10][11][12][13]. cfDNA wird unter physiologischen Bedingungen durch im Blut vorhandene DNAsen rasch abgebaut.…”

Biomarcadores prognósticos no traumatismo crânio-encefálico grave

“…(56,57) High plasma DNA concentrations were also related to severity of strokes. (58) Mechanisms by which free circulating DNA increases after trauma have not been established. High concentrations observed very early after injury, suggest that the extra-cell DNA originates from tissue damage (necrosis) while apoptosis mechanisms may contribute to persistent increases, in addition to a DNA clearance, probably impaired by commitment of the responsible organs due to systemic inflammation.…”