Plasma nuclear and mitochondrial DNA levels as predictors of outcome in severe sepsis patients in the emergency room.
OBJECTIVE
The sensitivity and specificity of biomarkers and scoring systems used for predicting fatality of severe sepsis patients remain unsatisfactory. This study aimed to determine the prognostic value of circulating plasma DNA levels in severe septic patients presenting at the Emergency Department (ED).


METHODS
Sixty-seven consecutive patients with severe sepsis and 33 controls were evaluated. Plasma DNA levels were estimated by real-time quantitative polymerase chain reaction assay using primers for the human β-hemoglobin and ND2 gene. The patients' clinical and laboratory data on admission were analyzed.


RESULTS
The median plasma nuclear and mitochondria DNA levels for severe septic patients on admission were significantly higher than those of the controls. The mean plasma nuclear DNA level on admission correlated with lactate concentration (γ = 0.36, p = 0.003) and plasma mitochondrial DNA on admission (γ = 0.708, p < 0.001). Significant prognostic factors for fatality included mechanical ventilation within the first 24 hours (p = 0.013), mean sequential organ failure assessment (SOFA) score on admission (p = 0.04), serum lactate (p < 0.001), and both plasma nuclear and mitochondrial DNA on admission (p < 0.001). Plasma mitochondrial DNA was an independent predictor of fatality by stepwise logistic regression such that an increase by one ng/mL in level would increase fatality rate by 0.7%.


CONCLUSIONS
Plasma DNA has potential use for predicting outcome in septic patients arriving at the emergency room. Plasma mitochondrial DNA level on admission is a more powerful predictor than lactate concentration or SOFA scores on admission.
Department of Emergency Medicine, Chang Gung University College ofMedicine, Kaohsiung, Taiwan.
Chia-Te
CT
Kung
Sheng-Yuan
SY
Hsiao
Tsung-Cheng
TC
Tsai
Chih-Min
CM
Su
Wen-Neng
WN
Chang
Chi-Ren
CR
Huang
Hung-Chen
HC
Wang
Wei-Che
WC
Lin
Hsueh-Wen
HW
Chang
Yu-Jun
YJ
Lin
Ben-Chung
BC
Cheng
Ben Yu-Jih
BY
Su
Nai-Wen
NW
Tsai
Cheng-Hsien
CH
Lu
D000368:Aged; D001483:Base Sequence; D016022:Case-Control Studies; D002467:Cell Nucleus / Q000235:genetics*; D004247:DNA / Q000097:blood*; D017931:DNA Primers; D004272:DNA, Mitochondrial / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000235:genetics
D017931:DNA Primers; D004272:DNA, Mitochondrial; D004247:DNA