Plasma cell‐free DNA and qSOFA score predict 7‐day mortality in 481 emergency department bacteraemia patients

Background A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell‐free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) pati...

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Published in:Journal of internal medicine 2018-10, Vol.284 (4), p.418-426
Main Authors: Rannikko, J., Seiskari, T., Huttunen, R., Tarkiainen, I., Jylhävä, J., Hurme, M., Syrjänen, J., Aittoniemi, J.
Format: Article
Language:English
Subjects:
bacteraemia
Bacteremia
biomarker
Cell culture
Death
Deoxyribonucleic acid
Disseminated intravascular coagulation
DNA
Electrical impedance
Emergency medical services
Infections
Markers
Medicin och hälsovetenskap
Mortality
Patients
Sepsis
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cited_by cdi_FETCH-LOGICAL-c4486-9e3d3756cf7d776277e75a2dac9f6b36c9ac546348ab3a211e53f62b396f55733
cites cdi_FETCH-LOGICAL-c4486-9e3d3756cf7d776277e75a2dac9f6b36c9ac546348ab3a211e53f62b396f55733
container_end_page 426
container_issue 4
container_start_page 418
container_title Journal of internal medicine
container_volume 284
creator Rannikko, J.
Seiskari, T.
Huttunen, R.
Tarkiainen, I.
Jylhävä, J.
Hurme, M.
Syrjänen, J.
Aittoniemi, J.
description Background A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell‐free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death. Methods Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture‐positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis‐3 definitions. The primary outcome was death by day 7. Results CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 μg mL−1 vs. 1.35 μg mL−1, P 1.69 μg mL−1) in 134 (28%) of 481 cases, and the qSOFA score was ≥2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score ≥2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. High cfDNA alone had odds ratio (OR) of 7.7 (95% CI 3.9–15.3) and qSOFA score ≥2 OR of 11.6 (5.5–24.3), but their combination had OR of 20.3 (10.0–41.4) in predicting death by day 7 when compared with those with low cfDNA and qSOFA score
doi_str_mv 10.1111/joim.12766
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We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death. Methods Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture‐positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis‐3 definitions. The primary outcome was death by day 7. Results CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 μg mL−1 vs. 1.35 μg mL−1, P &lt; 0.001). CfDNA level was high (&gt;1.69 μg mL−1) in 134 (28%) of 481 cases, and the qSOFA score was ≥2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score ≥2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. High cfDNA alone had odds ratio (OR) of 7.7 (95% CI 3.9–15.3) and qSOFA score ≥2 OR of 11.6 (5.5–24.3), but their combination had OR of 20.3 (10.0–41.4) in predicting death by day 7 when compared with those with low cfDNA and qSOFA score &lt;2. Amongst the five cases with the highest cfDNA levels, there were three patients with severe disseminated intravascular coagulation. Conclusion CfDNA and qSOFA score can be used independently to identify those bacteraemia patients at high risk of death, and combining these two markers gives additional advantage.</description><identifier>ISSN: 0954-6820</identifier><identifier>ISSN: 1365-2796</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/joim.12766</identifier><identifier>PMID: 29687943</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>bacteraemia ; Bacteremia ; biomarker ; Cell culture ; Death ; Deoxyribonucleic acid ; Disseminated intravascular coagulation ; DNA ; Electrical impedance ; Emergency medical services ; Infections ; Markers ; Medicin och hälsovetenskap ; Mortality ; Patients ; Sepsis</subject><ispartof>Journal of internal medicine, 2018-10, Vol.284 (4), p.418-426</ispartof><rights>2018 The Association for the Publication of the Journal of Internal Medicine</rights><rights>2018 The Association for the Publication of the Journal of Internal Medicine.</rights><rights>Copyright © 2018 The Association for the Publication of the Journal of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4486-9e3d3756cf7d776277e75a2dac9f6b36c9ac546348ab3a211e53f62b396f55733</citedby><cites>FETCH-LOGICAL-c4486-9e3d3756cf7d776277e75a2dac9f6b36c9ac546348ab3a211e53f62b396f55733</cites><orcidid>0000-0002-7199-6306</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29687943$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:139231545$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Rannikko, J.</creatorcontrib><creatorcontrib>Seiskari, T.</creatorcontrib><creatorcontrib>Huttunen, R.</creatorcontrib><creatorcontrib>Tarkiainen, I.</creatorcontrib><creatorcontrib>Jylhävä, J.</creatorcontrib><creatorcontrib>Hurme, M.</creatorcontrib><creatorcontrib>Syrjänen, J.</creatorcontrib><creatorcontrib>Aittoniemi, J.</creatorcontrib><title>Plasma cell‐free DNA and qSOFA score predict 7‐day mortality in 481 emergency department bacteraemia patients</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>Background A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell‐free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death. Methods Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture‐positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis‐3 definitions. The primary outcome was death by day 7. Results CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 μg mL−1 vs. 1.35 μg mL−1, P &lt; 0.001). CfDNA level was high (&gt;1.69 μg mL−1) in 134 (28%) of 481 cases, and the qSOFA score was ≥2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score ≥2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. High cfDNA alone had odds ratio (OR) of 7.7 (95% CI 3.9–15.3) and qSOFA score ≥2 OR of 11.6 (5.5–24.3), but their combination had OR of 20.3 (10.0–41.4) in predicting death by day 7 when compared with those with low cfDNA and qSOFA score &lt;2. Amongst the five cases with the highest cfDNA levels, there were three patients with severe disseminated intravascular coagulation. Conclusion CfDNA and qSOFA score can be used independently to identify those bacteraemia patients at high risk of death, and combining these two markers gives additional advantage.</description><subject>bacteraemia</subject><subject>Bacteremia</subject><subject>biomarker</subject><subject>Cell culture</subject><subject>Death</subject><subject>Deoxyribonucleic acid</subject><subject>Disseminated intravascular coagulation</subject><subject>DNA</subject><subject>Electrical impedance</subject><subject>Emergency medical services</subject><subject>Infections</subject><subject>Markers</subject><subject>Medicin och hälsovetenskap</subject><subject>Mortality</subject><subject>Patients</subject><subject>Sepsis</subject><issn>0954-6820</issn><issn>1365-2796</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhS0EokNhwwMgS-yQ0vrf8XLUUmhVOkjA2nKcG-Qhf2NnVGXHI_CMPAkumZYV9cbW0XfOvdZB6DUlJzSf0-0QuhPKtFJP0IpyJQumjXqKVsRIUaiSkSP0IqUtIZQTRZ6jI2ZUqY3gK7T73LrUOeyhbX___NVEAHx-s8aur_Huy-ZijZMfIuAxQh38hHWGajfjboiTa8M049BjUVIMHcTv0PsZ1zC6OHXQT7hyfoLooAsOj24KWUsv0bPGtQleHe5j9O3i_dezj8X15sPl2fq68EKUqjDAa66l8o2utVZMa9DSsdp506iKK2-cl0JxUbqKO0YpSN4oVnGjGik158eoWHLTLYz7yo4xdC7OdnDBHqQf-QVWlGWpWebNf_kxDvU_072RcsM4lUJm79vFm8HdHtJkt8M-9vl7Nm9GmCJS6Ey9Wygfh5QiNA8zKLF3Tdq7Ju3fJjP85hC5rzqoH9D76jJAF-A2tDA_EmWvNpefltA_MBaraQ</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Rannikko, J.</creator><creator>Seiskari, T.</creator><creator>Huttunen, R.</creator><creator>Tarkiainen, I.</creator><creator>Jylhävä, J.</creator><creator>Hurme, M.</creator><creator>Syrjänen, J.</creator><creator>Aittoniemi, J.</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-7199-6306</orcidid></search><sort><creationdate>201810</creationdate><title>Plasma cell‐free DNA and qSOFA score predict 7‐day mortality in 481 emergency department bacteraemia patients</title><author>Rannikko, J. ; Seiskari, T. ; Huttunen, R. ; Tarkiainen, I. ; Jylhävä, J. ; Hurme, M. ; Syrjänen, J. ; Aittoniemi, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4486-9e3d3756cf7d776277e75a2dac9f6b36c9ac546348ab3a211e53f62b396f55733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>bacteraemia</topic><topic>Bacteremia</topic><topic>biomarker</topic><topic>Cell culture</topic><topic>Death</topic><topic>Deoxyribonucleic acid</topic><topic>Disseminated intravascular coagulation</topic><topic>DNA</topic><topic>Electrical impedance</topic><topic>Emergency medical services</topic><topic>Infections</topic><topic>Markers</topic><topic>Medicin och hälsovetenskap</topic><topic>Mortality</topic><topic>Patients</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rannikko, J.</creatorcontrib><creatorcontrib>Seiskari, T.</creatorcontrib><creatorcontrib>Huttunen, R.</creatorcontrib><creatorcontrib>Tarkiainen, I.</creatorcontrib><creatorcontrib>Jylhävä, J.</creatorcontrib><creatorcontrib>Hurme, M.</creatorcontrib><creatorcontrib>Syrjänen, J.</creatorcontrib><creatorcontrib>Aittoniemi, J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rannikko, J.</au><au>Seiskari, T.</au><au>Huttunen, R.</au><au>Tarkiainen, I.</au><au>Jylhävä, J.</au><au>Hurme, M.</au><au>Syrjänen, J.</au><au>Aittoniemi, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma cell‐free DNA and qSOFA score predict 7‐day mortality in 481 emergency department bacteraemia patients</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2018-10</date><risdate>2018</risdate><volume>284</volume><issue>4</issue><spage>418</spage><epage>426</epage><pages>418-426</pages><issn>0954-6820</issn><issn>1365-2796</issn><eissn>1365-2796</eissn><abstract>Background A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell‐free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death. Methods Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture‐positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis‐3 definitions. The primary outcome was death by day 7. Results CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 μg mL−1 vs. 1.35 μg mL−1, P &lt; 0.001). CfDNA level was high (&gt;1.69 μg mL−1) in 134 (28%) of 481 cases, and the qSOFA score was ≥2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score ≥2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. 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subjects bacteraemia
Bacteremia
biomarker
Cell culture
Death
Deoxyribonucleic acid
Disseminated intravascular coagulation
DNA
Electrical impedance
Emergency medical services
Infections
Markers
Medicin och hälsovetenskap
Mortality
Patients
Sepsis
title Plasma cell‐free DNA and qSOFA score predict 7‐day mortality in 481 emergency department bacteraemia patients
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