Association of cell-free plasma DNA with perioperative mortality in patients with suspected acute mesenteric ischemia.
BACKGROUND
Diagnosing patients with acute mesenteric ischemia (AMI) in the emergency ward is challenging. This study assesses the usefulness of plasma DNA in patients with clinically suspected AMI.


METHODS
130 consecutive patients who underwent laparotomy were studied. Cell-free plasma DNA was measured by real-time quantitative PCR assay for the beta-globin gene. The primary endpoint was the accuracy of plasma DNA for predicting 30-day mortality.


RESULTS
Surgery revealed AMI in 99 patients and alternative diagnoses in 31 patients. Forty-six patients with AMI died (46.6%) as compared to 6 (19.4%) in the non-AMI group (p<0.05). The DNA concentration at admission was significantly higher in patients with AMI (median 7340 GE/ml, versus, 2735 GE/ml, p<0.01) and in AMI patients who died (8830 GE/ml, versus 4970 GE/ml, p<0.05). The area under the ROC curves for plasma DNA as a marker for mesenteric ischemia and independent predictor for 30-day mortality were 0.708 (95% CI 0.701-0.890) and 0.815 (95% CI 0.735-0.894). Multiple logistic regression analysis showed that the risk of hospital mortality increased 1.52-fold for every 1000 GE/ml increase in plasma DNA.


CONCLUSIONS
Plasma DNA levels may be a useful biomarker in predicting the outcome of patients with AMI.
Arnalich
Francisco
F
Emergency Medicine Service, Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain. farnalich.hulp@salud.madrid.org
Maldifassi
Maria Constanza
MC
Ciria
Enrique
E
Quesada
Angustias
A
Codoceo
Rosa
R
Herruzo
Rafael
R
Garcia-Cerrada
Carlos
C
Montoya
Fernando
F
Vazquez
Juan José
JJ
López-Collazo
Eduardo
E
Montiel
Carmen
C
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D002474:Cell-Free System; D004247:DNA / Q000097:blood*; D017931:DNA Primers; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000235:genetics* / Q000401:mortality; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012372:ROC Curve
D017931:DNA Primers; D004247:DNA