Department of Emergency, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
BMC Emerg Med. 2020 Apr 16;20(1):25. doi: 10.1186/s12873-020-00320-3.
The definition of sepsis is regularly updated; however, there is no standard diagnostic test. To improve diagnosis and prognostic prediction, the aim of this study was to determine the predictive value of circulating plasma mitochondrial DNA (mtDNA) levels in patients admitted to the emergency department (ED) with sepsis.
A total of 107 patients hospitalized from June 2018 to January 2019 were divided into the sepsis (n = 72) and septic shock (n = 35) groups based on the sepsis-3 definition. Clinical and laboratory data were measured within 24 h of admission. The mtDNA concentrations in clarified plasma were estimated by quantitative polymerase chain reaction. Binary logistic regression analysis and the receiver operating characteristic (ROC) curve were used to determine predictive value of mtDNA and other markers for sepsis outcome (28-day mortality).
The median plasma mtDNA levels on admission were significantly higher in the septic shock patients than in the sepsis patients (134,252(IQR 70215-203,184) vs. 59,945(IQR 13274-95,319) copies/μL, P < 0.01), and were also higher in non-survivors than in survivors within 28 days (165,291(IQR 89919-272,228)vs. 63,025(IQR 17031-98,401)copies/μL, P < 0.01). Binary logistic regression showed that plasma lactate and mtDNA levels were independent risk factors for 28-day mortality [odds ratio (OR) 1.341, 95% confidence interval (CI) 1.035-1.736, P = 0.026 and OR 13.299, 95%CI 2.765-63.956, P = 0.001, respectively). The area under the ROC curve values for plasma mtDNA levels, lactate concentration, and their combined were 0.781 (p < 0.001, 95%CI 0.671-0.891), 0.733 (p < 0.001, 95%CI 0.635-0.832), and 0.799 (p < 0.001, 95%CI 0.698-0.901), respectively. The calibration test for the combined variable showed X of 2.559 and P = 0.923.
A higher plasma mtDNA level was associated with a poor prognosis of sepsis in the emergency room, and could serve as a predictor of sepsis for 28-day mortality.
脓毒症的定义经常更新；然而，没有标准的诊断测试。为了改善诊断和预后预测，本研究的目的是确定循环血浆线粒体 DNA（mtDNA）水平在因脓毒症而入住急诊科的患者中的预测价值。
2018 年 6 月至 2019 年 1 月期间，共有 107 名住院患者根据脓毒症-3 定义分为脓毒症（n=72）和脓毒性休克（n=35）组。入院后 24 小时内测量临床和实验室数据。通过定量聚合酶链反应估计澄清血浆中的 mtDNA 浓度。二元逻辑回归分析和接收者操作特征（ROC）曲线用于确定 mtDNA 和其他标志物对脓毒症结局（28 天死亡率）的预测价值。
入院时，休克组患者的血浆 mtDNA 水平中位数明显高于脓毒症组（134,252（IQR 70215-203,184）vs. 59,945（IQR 13274-95,319）copies/μL，P<0.01），并且在 28 天内非幸存者的血浆 mtDNA 水平也高于幸存者（165,291（IQR 89919-272,228）vs. 63,025（IQR 17031-98,401）copies/μL，P<0.01）。二元逻辑回归显示，血浆乳酸和 mtDNA 水平是 28 天死亡率的独立危险因素[比值比（OR）1.341，95%置信区间（CI）1.035-1.736，P=0.026 和 OR 13.299，95%CI 2.765-63.956，P=0.001]。血浆 mtDNA 水平、乳酸浓度及其组合的 ROC 曲线下面积值分别为 0.781（p<0.001，95%CI 0.671-0.891）、0.733（p<0.001，95%CI 0.635-0.832）和 0.799（p<0.001，95%CI 0.698-0.901）。组合变量的校准检验显示 X 为 2.559，P=0.923。
较高的血浆 mtDNA 水平与急诊科脓毒症的不良预后相关，可作为预测脓毒症 28 天死亡率的指标。
