Naslov
Prognostic value of cell-free DNA in plasma of out-of-hospital cardiac arrest survivors quantified at ICU admission and 24 hours post- admission

Autori
Gornik, Ivan ; Gašparović, Vladimir ; Miličić, Davor ; Degoricija, Vesna ; Skorić, Boško ; Fortner, Eva ; Wagner, Jasenka ; Gornik Olga ; Lauc, Gordan

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Abstracts of the 26th Annual Congress of the European Society of Intensive Care Medicine (ESICM) Lives 2013. U: Intensive Care Medicine 2013 ; 39 (Supplement 2): S0929 / European Society of Intensive Care Medicine - Pariz : Springer, 2013, S0929-S0929

Skup
26th Annual Congress of the European Society of Intensive Care Medicine

Mjesto i datum
Pariz, Francuska, 05.10.2013. - 09.10.2013

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
cardiac arrest survivors; cel- free DNA; prognosis

Sažetak
Introduction: Cell-free DNA has been associated with outcome in several acute conditions including two reports concerning the outcomes after cardiac arrest that found association of circulating DNA quantities at admission with mortality. The origins of cell-free DNA are primarily necrosis and apoptosis, which in cardiac arrest occur during ischemia (“no-flow” and “low-flow” period), during reperfusion injury and as a consequence of post-arrest inflammatory response. Objectives: Respecting the facts that significant cellular damage may occur during the post-arrest period, and that damage might be reduced by mild therapeutic hypothermia, we investigated the prognostic value of cell-free DNA at ICU admission and 24 hours after admission. Methods: A prospective study was conducted in three intensive care units in university affiliated hospitals and included patients admitted after a non-traumatic out-of-hospital cardiac arrest and successful resuscitation. Patient data were collected in accordance with the Utstein protocol. Therapeutic hypothermia was performed according to ICU policies. Blood for cell-free DNA quantification was sampled at admission and at 24±1 hour after admission. Outcome measures were hospital morality and cerebral performance expressed with CPC scale at discharge. Results: Inclusion criteria were met in 67 patitenst ; 24-hour mortality was 37.3% and hospital mortality 71.6%. The following variables were associated with 24-hour mortality in univariate analysis: asystole as the presenting rhythm, “no-flow” time, “low-flow” time and cell- free DNA at admission (median 0.081 in survivors vs. 0.160 ng/µl in non-survivors ; P=0.038). Multivariate analysis that included the above variables showed that no-flow time and low-flow time were independently associated with 24-hour mortality. Hospital mortality was associated with following factors: “low flow” time, coronary intervention, cell-free DNA at ICU admission and at 24 hours after admission (0.042 vs. 0.188 ng/µl ; P=0.048). ROC curve for cell-free DNA 24 h post- admission showed sensitivity of 81.0% and specificity of 78.3% for the cut-off value of 0.115 ng/µl. Multivariate analysis showed that “low-flow” time and cell-free DNA at 24 hours after ICU admission were independently associated with hospital mortality. Cell free DNA showed different dynamics in patients who were and who were not treated with mild therapeutic hypothermia: it decreased in treated patients and slightly increased in non- treated patients. Conclusion: Cell-free DNA quantity at ICU admission and 24 h after admission is associated with hospital mortality. Further studies will need to additionally investigate possible practical use of this new laboratory marker in patients resuscitated from cardiac arrest.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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