Molecular medicine in the emergency room: plasma DNA in trauma

Abstract

Circulating cell-free plasma DNA is useful for the clinical diagnosis and prognosis of cancer patients, pregnant women and organ transplantation recipients, and may be liberated into plasma either as a result of apoptosis or direct injury. As bodily trauma involves considerable tissue damage, DNA may be liberated from tissues within minutes to hours after such injury. There is a positive correlation between early plasma DNA levels and injury severity, and levels are highest in those patients who develop the acute respiratory distress syndrome, multiple organ dysfunction syndrome and those who eventually die. Plasma DNA can be measured within minutes to hours after injury using a real-time, quantitative, polymerase chain reaction assay. Using DNA and other markers entered into a Classification and Regression Tree, it is possible to derive a prediction rule for post-traumatic complications with high sensitivity, specificity and positive predictive values. These guidelines require prospective validation before they find a place as research tools.