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Table 2 CfDNA’s ability to predict outcomes

From: The role of total cell-free DNA in predicting outcomes among trauma patients in the intensive care unit: a systematic review

Article/outcomes

Survival

Complications

Severity score

Cut-off

Nonspecific trauma

 Ren et al. [37]

NA

Not able to predict secondary infection

No significant correlation between cfDNA and ISS

700 copies/L plasma sensitivity: 41.1% specificity: 96.7% PPV: 95.85% NPV: 46.8%

 Margraf et al. [15]

Lower levels of cfDNA had a NPV of 100% for MOF and death

Higher levels of cfDNA on admission and on days 7–10 was significantly associated with sepsis

Higher levels of cfDNA correlated with higher ISS scores.

NA

 Lo et al. [14]

All patients undergoing death had significantly higher cfDNA than survivors

ALI and ARDS patients had significantly higher cfDNA than patients without this diagnosis

Higher levels of cfDNA correlated with higher ISS scores.

232.719 KE/L had a sensitivity and specificity for death of 78% and 82%, respectively

 Wijeratne et al. [39]

2.3-fold higher cfDNA in nonsurvivors than in survivors (no p value)

Ventilated patients had significantly higher cfDNA values than nonventilated patients

Higher levels of cfDNA correlated with higher SOFA scores but not with APACHE II

6.109 GE/mL sensitivity and specificity at 85% and 80%, respectively, for death

 Lam et al. [29]

Study 1: NA Study 2: NA

Study 1: statistical difference between patients with OF and nonOF patients Study 2: on days 2, 3, 4, and 5 patients with MODS had significantly higher cfDNA that nonMODS patients

Study 1: At 1 h, 2 h, 3 h cfDNA significantly higher in patients with severe injury compared to less severely injured patients. Study 2: NA

NA

 McIlroy et al. [43]

Not powered

No correlation between levels of mtDNA or nDNA in relation to SIRS or MOF

Not powered

Not powered

 Yamanouchi et al. [34]

Significantly higher mtDNA in nonsurvivors compared to survivors (2 patients died)

No correlation with SOFA or APACHE II scores

High mtDNA significantly correlated with high ISS score (p < 0.05)

NA

 Lam et al. [36]

Significantly higher mtDNA in nonsurvivors compared to survivors (2 patients died)

NA

Patients with severe injury (ISS >16) had significantly higher mtDNA than patients with minor/moderate injury (ISS < 16). Similar results for nDNA

NA

 Gu et al. [35]

NA

mtDNA on ICU admission able to predict SIRS (p < 0.001)

mtDNA significantly correlated to high APACHE II score(p = 0.034) and ISS score (p < 0.001)

Cut-off value of mtDNA 1.3185 μg/ml with a sensitivity of 67% and specificity of 75%

Traumatic brain injury

 Macher et al. [30]

Significantly higher decrease of cfDNA from 0 to 24 h in survivors than in nonsurvivors

Patients with high GCS score (11–15) had significantly lower serum DNA levels at admission and 24 h than severe TBI patients

Patients with high APACHE II (<15) score and ISS had significantly higher cfDNA that patients with lower APACHE II score and ISS at 24 h

A cut-off ratio of 1.95 had a sensitivity and specificity of 70% and 66%, respectively

 Shaked et al. [31]

Significantly higher levels of cfDNA in nonsurvivors than in survivors

Significantly higher cfDNA in patients with GOS score ≤4 vs patients with GOS score 5

 

A cut-off ratio of 700 ng/ml had a sensitivity and specificity of 82% and 59% to predict GOS <5

 Yurgel et al. [32]

Significantly higher levels of cfDNA at 24 h in nonsurvivors than in survivors

 

No difference in cfDNA between isolated TBI and TBI with extracranial injuries

77,883,5 KE/L at 24 h with a sensitivity and specificity of 67% and 76% for mortality

 Filho et al. [33]

Significantly higher levels of cfDNA in nonsurvivors than in survivors

High cfDNA levels on admission siginificantly associated with death

Significantly higher cfDNA in patients with lower GCS score compared with patients with higher GCS score

171.381 KE/L plasma sensitivity of 43%, specificity of 90%

 Wang et al. [16]

nDNA had significantly higher levels on days 1, 4, and 7 in patients with poor outcome compared to patients with good outcome

High nDNA significantly correlated with low GCS

High nDNA significantly correlated with high ISS score

72.95 ng/ml sensitivity of 87.5%, specificity of 86.2%

  1. AIS abbreviated injury scale, ALI acute lung injury, APACHE Acute Physiology and Chronic Health Evaluation, ARDS acute respiratory distress syndrome, cfDNA cell-free DNA, GCS Glasgow Coma Scale, GE genome equivalent, GOS Glasgow outcome scale, ICU intensive care unit, ISS Injury Severity Score, KE kilo equivalent, MODS multiple organ dysfunction syndrome, MOF multi-organ failure, mtDNA circulating mitochondrial DNA, NA not available, nDNA circulating nuclear DNA, NPV negative predictive value, OF organ failure, PPV positive predictive value, SOFA Sepsis-related Organ Failure Assessment, SIRS systemic inflammatory response syndrome, TBI traumatic brain injury