Sepsis败血症.ppt

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1、Plasma DNA concentration as a predictor of mortality and sepsis in critically ill patientsAndrew Rhodes,Stephen J Wort,Helen Thomas,et alCrit Care.2006;10(2):R60 Sepsis:败血症Commented by MU Yuan08-06-26Critical Care(1466-609X)Critical Care:危重症医学IF:3.11(2006);3.83(2007)Scope:in all areas of intensive c

2、are and emergency medicine.Cardiology,Infection,Metabolism,MOF/Sepsis,Nephrology,Neurology,Paediatrics,Resource Management,Respirology,Shock,Toxicology,Trauma and ResuscitationAdvisory Board:Pro.Bin Du(杜斌)Director,Medical ICUPeking Union Medical College Hospital,ChinaResuscitation:复苏FeatureOnline:Fr

3、om January 2006 Critical Care is not available in print and is only published online.()Fast:An initial decision on manuscript submission within 5 weeks,publication online within 28 days.allows authors to include additional files such as films or large datasetsBackgroundPrognosis of patients is impor

4、tant in risk stratification(危险度分级)and for efficient use of hospital resources.Numerous biomarkers have been evaluated to predict morbidity and mortality in the intensive care setting:cytokines,procalcitonin,CRP,BNP,cTnRecently interest has developed in the use of plasma DNA,or cell-free nucleic acid

5、,as a prognostic marker.The plasma DNA concentration taken soon after the accident is predictive of death with a sensitivity and a specificity of 100%and 81%,respectively.(by Lo YM)Sepsis is a major cause of morbidity and mortality in patients in the ICU and is associated with cell necrosis and apop

6、tosis.Procalcitonin:原降钙素Brain Natriuretic Peptide:脑钠肽AimTo assess the significance of raised levels of plasma DNA on admission to the intensive care unit (ICU)in terms of its ability to predict disease severity or prognosis.Materials and methodsCases:52;Control:10 healthy volunteersCharacteristics:r

7、eason for admission,complications in the first 24 hours,length of stay,ICU and hospital mortality,SOFA score(感染相关的器官衰竭评分)Patients were followed up three months after discharge from the ICU.Sample Collection:EDTA blood samples were taken from indwelling intra-arterial access on admission to the ICU,s

8、eparated within 3 hours.Procedure:3000rpm,6min;separation into a 1.5 ml tube;14000rpm,10minExtraction of DNA:200l plasma using“High Pure PCR Template Preparation kit”(Roche,Lewes,UK)Amplification:Target Gene:-haemoglobin,101bp ampliconAbsolute quantification:standard curve was accomplished using hum

9、an genomic DNAInstrument:Roche LightCycleDNA bound to special glass fibers is purified in a series of wash-and-spin stepsResults Plasma DNA(ng/ml)P ValueControls17(1419)0.001Patients80(48260)Plasma DNA and severity of illnessmechanical ventilation (P=0.27)weather or notoperation(P=0.26)inotropic sup

10、port(P=0.007)plasma DNA and SOFA score:r2=0.2,P=0.002Plasma DNA and outcomesepsis higher than nonsepsis(192(65362)ng/ml versus 74(46156)ng/ml,P=0.03)Survivors versus Nonsurvivors,P=0.001No correlation was found between plasma DNA and CRP,BNP procalcitonin.Logistic regressionvariance:age,sex ratio,op

11、eration,SOFA score,plasma DNAThe Plasma DNA was the only independent factor that could predict ICU mortality(odds ratio:1.002,P=0.05).Prognostic ability of plasma DNA ROC curves:for plasma DNA to predict ICU and hospital deaths were 0.84 and 0.79;for the SOFA score to predict ICU mortality was 0.76T

12、he optimal cutoff value:127 ng/ml(sensitivity of 92%and a specificity of 80%)DiscussionDifference between controls and normal reference range highlights:assay methodology(such as,different PCR-based methodology);racial variation;need for a common reference rangeNo correlation between plasma DNA and

13、three biomarkers highlights:different mechanisms necessary for releaseischaemia-reperfusion,haemolysis,complement-related pathwaysSOFAother scoring systems of illness severityConclusionThe plasma DNA was shown to be superior to the SOFA scoring system in predicting ICU mortality and could predict inhospital mortality at 3 months.CommentsHow to draw a conclusion,from phenomenon to essence.Illumination