Name: LIVIA MARIA DE ARAUJO MAIA CLAUDIO
Publication date: 03/12/2019
Examining board:
Name |
Role |
|---|---|
| JOSE GERALDO MILL | Internal Examiner * |
Summary: Introduction: Sepsis is a systemic response of the body to a microbial
infection. It is estimated that 19 million cases worldwide occur each year with
high case fatality rates and is considered a serious public health problem.
Diagnosing sepsis remains a major challenge for healthcare professionals, and
so far, there is no gold standard for diagnosing sepsis. New biomarkers, such
as cfDNA, have been studied in sepsis to improve diagnosis and allow early
therapeutic intervention. Objective: To investigate the value of cfDNA as a
predictor of severity in septic patients and its association with organ dysfunction
score. Methods: 124 patients who had the sepsis protocol started were divided
into infection (n=37) and sepsis/septic shock (n=87). Clinical and
epidemiological data were obtained from medical records. Blood samples were
collected at diagnosis and cfDNA concentrations were measured by the direct
fluorescence technique. Results were presented in ng/ml. Results: cfDNA
concentrations were higher according to disease severity. Higher cfDNA values
(p<0.01) were observed in patients with sepsis and septic shock (median 186.2;
ng/ml, IQR 117.1-363.5) compared with patients with infection (median 113,5
ng/ml; IQR 66.1-210.3). Infected patients (n=37) who progressed to
sepsis/septic shock (n = 13) had higher cfDNA concentrations (median 212
ng/ml; IQR 7.18-270.3) compared to patients who did not progress to organ
dysfunction (median 100.3 ng/ml; IQR 59.35-186.5), p=0.012. In multivariate
regression analysis, only cfDNA concentration (95% CI 1.002-1.012, p<0.01)
and SOFA score (95% CI 1.579-3.730, p<0.01) were strong and significant
predictors of severity. By ROC analysis, plasma cfDNA had less discriminative
power (AUC 0.69, 95% CI 0.63-0.79) than the SOFA score to predict the
severity of infection (AUC 0.88, 95% CI 0.82-0.94). Conclusion: cfDNA was an
independent predictor of severity in septic patients, but with lower discriminatory
power than SOFA, the clinical score used in clinical practice.
