title: Admission cell free DNA levels predict 28-day mortality in patients with severe sepsis in intensive care.
abstract: OBJECTIVE
  The aim of the current study is to assess the mortality prediction accuracy of circulating cell-free DNA (CFD) level at admission measured by a new simplified method.
  
  
  METHODS
  CFD levels were measured by a direct fluorescence assay in severe sepsis patients on intensive care unit (ICU) admission. In-hospital and/or twenty eight day all-cause mortality was the primary outcome.
  
  
  RESULTS
  Out of 108 patients with median APACHE II of 20, 32.4% have died in hospital/or at 28-day. CFD levels were higher in decedents: median 3469.0 vs. 1659 ng/ml, p<0.001. In multivariable model APACHE II score and CFD (quartiles) were significantly associated with the mortality: odds ratio of 1.05, p = 0.049 and 2.57, p<0.001 per quartile respectively. C-statistics for the models was 0.79 for CFD and 0.68 for APACHE II. Integrated discrimination improvement (IDI) analyses showed that CFD and CFD+APACHE II score models had better discriminatory ability than APACHE II score alone.
  
  
  CONCLUSIONS
  CFD level assessed by a new, simple fluorometric-assay is an accurate predictor of acute mortality among ICU patients with severe sepsis. Comparison of CFD to APACHE II score and Procalcitonin (PCT), suggests that CFD has the potential to improve clinical decision making.
authors: Pulmonology Institute, Department of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Avital
authors: A
authors: Avriel
authors: Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Maya
authors: M
authors: Paryente Wiessman
authors: Medical Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Yaniv
authors: Y
authors: Almog
authors: Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Yael
authors: Y
authors: Perl
authors: Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Victor
authors: V
authors: Novack
authors: General Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ori
authors: O
authors: Galante
authors: General Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Moti
authors: M
authors: Klein
authors: Duke Clinical Research Institute, Durham, North Carolina, United States of America.
authors: Michael J
authors: MJ
authors: Pencina
authors: Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Amos
authors: A
authors: Douvdevani
mesh_terms: D018806:APACHE; D003422:Critical Care; D004247:DNA / Q000032:analysis* / Q000235:genetics; D005260:Female; D005453:Fluorescence; D005470:Fluorometry; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate
chemical_list: D004247:DNA