The Role of Extracellular DNA Among Predictors of Hospital Mortality in Patients with Septic Shock

Introduction. Extracellular DNA (exDNA) is a well-known but poorly understood mediator of sepsis. The aim was to investigate the role of exDNA as an independent predictor of mortality and as a marker of unfavorable clinical phenotype for patients with septic shock.

Material and methods. The patients over the age of 18 with septic shock (Sepsis-3 criteria) who were admitted to the intensive care unit of the S.S. Yudin City Clinical Hospital between August 2023 and May 2024 were included in a prospective observational study.

Results. Total of fifty-two patients (64% men, 36% women) aged 52.1 ± 17.3 years, with severity of the condition on the SOFA score 10±4 and APACHE II score — 22±7 were included. The exDNA concentration was 3041 (876–7815.0) ng/ml. For exDNA, a significant (p=0,031) association with 28-day mortality was determined (AUC 0.69, 95% CI (0.54–0.84)), and a cut-off point >1893 ng/ml was identified, at which the OR of the hospital death corresponded to 4.3 (95% CI 1.3–15.1, p=0.03). The dependence of the risk of death on the concentration of exDNA (<1893 or >1893 ng/ml), estimated using the Mantel-Cox log-rank test, was statistically significant (p=0.028). The median survival time in the exDNA group >1893 ng/ml was 7 days, and for exDNA levels <1893 ng/ml — 11 days. Independent predictors of exDNA concentrations >1893 ng/ml in patients with septic shock were the level of mixed venous blood lactate (OR 2.0; 95% CI [1.02, 3.92], p=0.044) and SOFA score (OR 1.23; 95% CI [1.02, 1.47], p=0.029).

Conclusion. The exDNA level is an independent predictor of mortality in septic shock. Its cut-off point of 1893 ng/ml could be considered as an indication for extracorporeal elimination of exDNA. Point of care laboratory markers of a significant increase in the blood concentration of exDNA were also identified and could be considered as a guide to an intensive care.

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