Whole-Blood Mitochondrial DNA Copies Are Associated With the Prognosis of Acute Respiratory Distress Syndrome After Sepsis

Acute respiratory distress syndrome (ARDS) is an inflammatory process of the lungs that develops primarily in response to pulmonary or systemic sepsis, resulting in a disproportionate death toll in intensive care units (ICUs). Given its role as a critical activator of the inflammatory and innate immune responses, previous studies have reported that an increase of circulating cell-free mitochondrial DNA (mtDNA) is a biomarker for fatal outcome in the ICU. Here we analyzed the association of whole-blood mtDNA (wb-mtDNA) copies with 28-day survival from sepsis and sepsis-associated ARDS. We analyzed mtDNA data from 687 peripheral whole-blood samples within 24 h of sepsis diagnosis from unrelated Spanish patients with sepsis (264 with ARDS) included in the GEN-SEP study. The wb-mtDNA copies were obtained from the array intensities of selected probes, with 100% identity with mtDNA and with the largest number of mismatches with the nuclear sequences, and normalized across the individual-probe intensities. We used Cox regression models for testing the association with 28-day survival. We observed that wb-mtDNA copies were significantly associated with 28-day survival in ARDS patients (hazard ratio = 3.65, 95% confidence interval = 1.39–9.59, p = 0.009) but not in non-ARDS patients. Our findings support that wb-mtDNA copies at sepsis diagnosis could be considered an early prognostic biomarker in sepsis-associated ARDS patients. Future studies will be needed to evaluate the mechanistic links of this observation with the pathogenesis of ARDS.

[Spinal cord dural arteriovenous fistulae: analysis of a series with surgical curative treatment]

BACKGROUND

Spinal dural arteriovenous fistulae (SDAVF) are elusive to an early diagnosis. Otherwise, there is no agreement regarding the best treatment.

AIM

To review our series of spinal arteriovenous malformations to illustrate the treatment and outcome of FAVDE.

PATIENTS AND METHODS

Descriptive series of cases diagnosed and treated at our hospital within the last ten years. Ten suspicious MRI, followed by angiograms, got the next diagnosis: 3 intraspinal malformations, 2 cavernoms and 5 FAVDE, reported here.

RESULTS

Four out of 5 FAVDE were men. Mean age was 61year (53-77), and mean interval to diagnosis 10.8 months (1-24). The clinical course consisted of progressive paraparesis, wich was acute in one case, with wheelchair confinement. Sensory involvement and sphinter dysfunction were also always present; severe pain affected 2 cases. MRI revealed the FAVDE at low thoracic or lumbar levels, with tortuous flow voids over the surface of the affected area. Angiograms disclosed the single feeding vessel between D8-L3. Laminectomy and interruption of the draining vein was the chosen treatment. Postoperative complications were not found. Improvement followed until full recovery, that occurred in 4 cases. One patient, previously embolized, was the only one with just modest recovery, although the angiogram proved that deferred surgery ran well. Mean follow-up was 3.8 years (1.5-6); neither clinical deterioration nor suspicious MR finding were found. Postoperative angiogram, performed in two cases, confirmed the fistulae as occluded.

CONCLUSIONS

FAVDE mainly involves old males with progressive paraparesis. Suitable MR findings and characteristic angiograms allow the diagnosis. Novel patients are subsidiary to selective and simple surgery, that is usually curative without recurrencies.