Association of cell-free plasma DNA with perioperative mortality in patients with suspected acute mesenteric ischemia

Background: Diagnosing patients with acute mesenteric ischemia (AM!) in the emergency ward is challenging. This study assesses the usefulness of plasma DNA in patients with clinically suspected AMI. Methods: 130 consecutive patients who underwent laparotomy were studied. Cell-free plasma DNA was measured by real-time quantitative PCR assay for the beta-globin gene. The primary endpoint was the accuracy of plasma DNA for predicting 30-day mortality. Results: Surgery revealed AMI in 99 patients and alternative diagnoses in 31 patients. Forty-six patients with AMI died (46.6%) as compared to 6 (19.4%) in the non-AMI group (p<0.05). The DNA concentration at admission was significantly higher in patients with AMI (median 7340 GE/ml, versus, 2735 GE/ml, p<0.01) and in AMI patients who died (8830 GE/ml, versus 4970 GE/ml, p<0.05). The area under the ROC curves for plasma DNA as a marker for mesenteric ischemia and independent predictor for :30-day mortality were 0.708 (95% CI 0.701-0.890) and 0.815 (95% CI 0.735-0.894). Multiple logistic regression analysis showed that the risk of hospital mortality increased 1.52-fold for every 1000 GE/ml increase in plasma DNA. Conclusions: Plasma DNA levels may be a useful biomarker in predicting the outcome of patients with AMI. (C) 2010 Elsevier B.V. All rights reserved.