Avriel Avital, Paryente Wiessman Maya, Almog Yaniv, Perl Yael, Novack Victor, Galante Ori, Klein Moti, Pencina Michael J, Douvdevani Amos
Pulmonology Institute, Department of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
PLoS One. 2014 Jun 23;9(6):e100514. doi: 10.1371/journal.pone.0100514. eCollection 2014.
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.
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.
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.
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.
本研究旨在评估采用一种新的简化方法测量的入院时循环游离DNA（CFD）水平对死亡率的预测准确性。
采用直接荧光分析法对入住重症监护病房（ICU）的严重脓毒症患者入院时的CFD水平进行测量。以院内和/或28天全因死亡率作为主要结局。
108例患者的急性生理与慢性健康状况评分系统（APACHE II）中位数为20，其中32.4%在院内和/或28天时死亡。死亡患者的CFD水平更高：中位数分别为3469.0 ng/ml和1659 ng/ml，p<0.001。在多变量模型中，APACHE II评分和CFD（四分位数）与死亡率显著相关：每增加一个四分位数，比值比分别为1.05，p = 0.049和2.57，p<0.001。CFD模型的C统计量为0.79，APACHE II模型的C统计量为0.68。综合判别改善（IDI）分析表明，CFD模型以及CFD + APACHE II评分模型比单独的APACHE II评分模型具有更好的判别能力。
采用一种新的简单荧光分析法评估的CFD水平是重症监护病房严重脓毒症患者急性死亡率的准确预测指标。将CFD与APACHE II评分及降钙素原（PCT）进行比较表明，CFD有改善临床决策的潜力。
