title: Neutrophil-derived circulating free DNA (cf-DNA/NETs), a potential prognostic marker for mortality in patients with severe burn injury.
abstract: The predictive value of circulating free DNA/neutrophil extracellular traps (cf-DNA/NETs) has recently been shown in patients with major trauma for sepsis, multiple organ failure, and mortality. Here we report on the predictive potential of cf-DNA/NETs for mortality in patients with severe burn injury. In a prospective study 32 patients with severe burn injury were included. Blood samples were sequentially obtained on day 1, 3, 5, and 7 after admission. cf-DNA/NETs was directly quantified from plasma by means of rapid fluorescence assay. Time kinetics of cf-DNA/NETs were correlated with clinical data, C-reactive protein (CRP), procalcitonin (PCT), and interleukin (IL)-6. Furthermore sensitivity, specificity, and positive and negative predictive value, as well as receiver operation characteristic (ROC) curves were calculated. Seven patients died within the first month after burn injury. cf-DNA/NETs values from these patients were significantly increased already on day 1 and 3 after admission compared with patients who survived (p < 0.01). In contrast, PCT levels of nonsurvivors were significantly elevated on day 3 and 5 (p < 0.01), while CRP and IL-6 did not show any significant difference between survivors and nonsurvivors. At a cutoff of 255 ng/ml, cf-DNA/NETs had sensitivity of 0.8 and specificity of 0.74. ROC revealed largest areas under the curve (AUC) for cf-DNA/NETs on day 1 (0.851) and 3 (0.883) after admission. For all values between day 1 and 7, AUC was 0.815. cf-DNA/NETs seems to be a rapid, valuable marker for prediction of mortality in burn patients. A larger confirmation trial ought to be carried out.
authors.affiliation: Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Altrichter
authors.affiliation: Department of Surgery, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Zedler
authors.affiliation: Department of Surgery, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
authors.affiliation: Department of Surgery, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Eugen
authors.initials: E
authors.lastname: Faist
authors.affiliation: Department of Internal Medicine, University of Rostock, Rostock, Germany.
authors.forename: Steffen R
authors.initials: SR
authors.lastname: Mitzner
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Rostock, Rostock, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sauer
authors.affiliation: Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.affiliation: Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany. martin.scholz@uni-duesseldorf.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Scholz
authors.affiliation: Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Lögters
keywords: Circulating free DNA; Inflammation; Neutrophil extracellular traps (NETs); Neutrophils; Outcome
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