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- Title
A Novel Assay for Neutrophil Extracellular Trap Formation Independently Predicts Disseminated Intravascular Coagulation and Mortality in Critically Ill Patients.
- Authors
Abrams, Simon T.; Morton, Ben; Alhamdi, Yasir; Alsabani, Mohmad; Lane, Steven; Welters, Ingeborg D.; Guozheng Wang; Cheng-Hock Toh; Wang, Guozheng; Toh, Cheng-Hock
- Abstract
Rationale: Neutrophil extracellular traps (NETs) are important in the host defense against infection, but they also promote intravascular coagulation and multiorgan failure in animal models. Their clinical significance remains unclear, and available assays for patient care lack specificity and reliability.Objectives: To establish a novel assay and test its clinical significance.Methods: A prospective cohort of 341 consecutive adult ICU patients was recruited. The NET-forming capacity of ICU admission blood samples was semiquantified by directly incubating patient plasma with isolated neutrophils ex vivo. The association of NET-forming capacity with Sequential Organ Failure Assessment scores, disseminated intravascular coagulation, and 28-day mortality was analyzed and compared with available NET assays.Measurements and Main Results: Using the novel assay, we could stratify ICU patients into four groups with absent (22.0%), mild (49.9%), moderate (14.4%), and strong (13.8%) NET formation, respectively. Strong NET formation was predominantly found in sepsis (P < 0.0001). Adjusted by Acute Physiology and Chronic Health Evaluation II score, multivariate regression showed that the degree of NET formation could independently predict disseminated intravascular coagulation and mortality, whereas other NET assays (e.g., cell-free DNA, myeloperoxidase, and myeloperoxidase-DNA complexes) could not. IL-8 concentrations were found to be strongly associated with NET formation, and inhibiting IL-8 significantly attenuated NETosis. Mitogen-activated protein kinase activation by IL-8 has been identified as a major pathway of NET formation in patients.Conclusions: This assay directly measures the NET-forming capacity in patient plasma. This could guide clinical management and enable identification of NET-inducing factors in individual patients for targeted treatment and personalized ICU medicine.
- Subjects
APACHE (Disease classification system); CARDIOVASCULAR diseases; CATASTROPHIC illness; COMPARATIVE studies; DISSEMINATED intravascular coagulation; EXTRACELLULAR space; GASTROINTESTINAL diseases; HEALTH status indicators; INTENSIVE care units; INTERLEUKINS; KIDNEY diseases; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MORTALITY; MULTIVARIATE analysis; NEUROLOGICAL disorders; NEUTROPHILS; RESEARCH; RESEARCH evaluation; RESEARCH funding; RESPIRATORY diseases; RISK assessment; SEPSIS; TRANSFERASES; WOUNDS &; injuries; EVALUATION research
- Publication
American Journal of Respiratory & Critical Care Medicine, 2019, Vol 200, Issue 7, p869
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201811-2111OC