Background: Despite advances in critical care management and in the understanding of its physiopathology, sepsis remains a serious problem. In sepsis, thrombus formation is a complication that increases the risk of death and the severity of organ dysfunction. Due to SOFA score limitations, it is imperative to find reliable biomarkers to improve it or generate a better predictive score.
Aims: Our aims were to study two plasmatic biomarkers derived from different cell death mechanisms: cell-freeDNA (cfDNA) and citrullinated histone H3 (H3cit) within the first hours of admission in the ICU to evaluate their predictive value in the prognosis of sepsis.
Methods: 203 septic patients (median age:45 years[33.5-54.5];women: 37.1%) have been recruited, of whom 94 survived (median age:42.5 years[28.75-53.50];women: 35.72%) and 109 died (median age:46 years [35-55];women: 42.18%). As a reference, cfDNA and H3cit levels were measured in 85 selected healthy controls (median age:30 years[25-39];women: 56.5%).
Results: Both cfDNA and H3cit median plasmatic levels were significantly higher in septic patients that survived than in those patients who died in ICU (Figures 1/2). Moreover, cfDNA and H3cit levels showed a positive correlation between them (rho Spearman’s correlation coefficient: ρ=0.445; p< 0.01).
We found that having cfDNA levels higher than 2.27 ng/ul (the 75th percentile among patients) would significantly increase the odds of sepsis associated mortality (OR=3.08 [1.53-6.10]; p=0.002; binary logistic regression).
Finally, we made a preliminary analysis to compare the traditional SOFA score, cfDNA and H3cit categorized levels as predictors of mortality in sepsis. So far, SOFA score seemed to be a better predictor (AUC=0.780 vs AUC=0.732 vs AUC=0.683, respectively). However, adding these plasmatic biomarkers to the SOFA score slightly increase its predictive ability (AUC=0.796).
Conclusions: Our results could be promising to consider the measurement of cfDNA and H3cit levels as useful biomarkers to be incorporated to the SOFA score for sepsis prognosis.
To cite this abstract in AMA style:Moiana M, Cunto E, Dominguez C, Chediack V, Perés S, de Larrañaga G. Cell-free DNA and Citrullinated Histone H3 Plasma Levels Improve the Prediction of Mortality in Septic Patients [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/cell-free-dna-and-citrullinated-histone-h3-plasma-levels-improve-the-prediction-of-mortality-in-septic-patients/. Accessed November 26, 2020.
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