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Neutrophil-derived circulating free DNA (cf-DNA/NETs), a potential prognostic marker for mortality in patients with severe burn injury

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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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Acknowledgments

We are grateful for the collaboration with the medical staff of the ICU (burn center) at Municipal Hospital Munich-Bogenhausen, Germany (Director: Prof. Dr. med. M. Ninkovic). For statistical analyses we thank Dr. Teresa Jeri.

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Authors and Affiliations

  1. Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany

    Jens Altrichter, Joachim Windolf, Martin Scholz & Tim Lögters

  2. Department of Surgery, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany

    Siegfried Zedler, Robert Kraft & Eugen Faist

  3. Department of Internal Medicine, University of Rostock, Rostock, Germany

    Steffen R. Mitzner

  4. Department of Anesthesiology and Intensive Care, University of Rostock, Rostock, Germany

    Martin Sauer

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  1. Jens Altrichter
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  2. Siegfried Zedler
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  3. Robert Kraft
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  4. Eugen Faist
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  5. Steffen R. Mitzner
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  6. Martin Sauer
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  7. Joachim Windolf
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  8. Martin Scholz
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  9. Tim Lögters
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Correspondence to Martin Scholz.

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Altrichter, J., Zedler, S., Kraft, R. et al. Neutrophil-derived circulating free DNA (cf-DNA/NETs), a potential prognostic marker for mortality in patients with severe burn injury. Eur J Trauma Emerg Surg 36, 551–557 (2010). https://doi.org/10.1007/s00068-010-0013-1

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  • DOI: https://doi.org/10.1007/s00068-010-0013-1

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