Neutrophil-derived circulating free DNA (cf-DNA/NETs), a potential prognostic marker for mortality in patients with severe burn injury |
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Authors: | Jens Altrichter Siegfried Zedler Robert Kraft Eugen Faist Steffen R Mitzner Martin Sauer Joachim Windolf Martin Scholz Tim Lögters |
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Institution: | 1. Department of Trauma and Hand Surgery, Universit?tsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany 2. Department of Surgery, Klinikum Gro?hadern, Ludwig-Maximilians University, Munich, Germany 3. Department of Internal Medicine, University of Rostock, Rostock, Germany 4. Department of Anesthesiology and Intensive Care, University of Rostock, Rostock, Germany
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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. |
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