title: Circulating cell-free DNA levels correlate with postresuscitation survival rates in out-of-hospital cardiac arrest patients.
abstract: Early prediction of prognosis is helpful in cardiac arrest patients. Plasma cell-free DNA, which increases rapidly after cell death, is a novel biomarker for the prognosis of critical ill patients. Changes in the plasma cell-free DNA level and its role for the early prognosis of cardiac arrest patients remain unclear. We prospectively enrolled adult out-of-hospital cardiac arrest (OHCA) patients with sustained return of spontaneous circulation. The resuscitation variables were recorded following the Utstein recommendation. The plasma cell-free DNA concentration was determined by quantitative real-time polymerase chain reaction assay of β-globin gene. A total of 42 patients were enrolled for the study. The plasma cell-free DNA level within 2h after cardiac arrest was higher in the non-survival group than the survival-to-discharge group (median level 1659.9 g.e./mL vs. 1121.6g.e./mL, p=0.003 by non-parametric test). The plasma cell-free DNA level at 72 h became no difference between these two groups. The optimal cutoff value of plasma cell-free DNA for predicting survival-to-discharge was 1,170 g.e./mL by ROC curve analysis (area under curve 0.752, p=0.010). A plasma cell-free DNA level higher than 1,170 g.e./mL and was an independent predictor for in-hospital mortality by multiple logistic regression analysis (adjusted odds ratio of 12.35, p=0.023) and was also associated with higher 90 day mortality (p=0.021 by log-rank test). In conclusion, the plasma cell-free DNA level increases during the early post-cardiac arrest phase and can be an early prognostic factor for OHCA patients.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University Medical College, Taipei, Taiwan.
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Huang
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Tsai
authors.forename: Chiung-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Huei-Wen
authors.initials: HW
authors.lastname: Chen
authors.forename: Tzung-Dau
authors.initials: TD
authors.lastname: Wang
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D004247:DNA / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D060888:Real-Time Polymerase Chain Reaction; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055544:beta-Globins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D055544:beta-Globins; D004247:DNA