Value of dynamic plasma cell-free DNA monitoring in septic shock syndrome: A case report

Abstract

Background: Mortality due to septic shock is relatively high. The dynamic monitoring of plasma cell-free DNA (cfDNA) can guide the treatment of septic shock.

Case summary: Herein, we present a typical case of septic shock syndrome caused by the bacilli Acinetobacter baumannii and Pantoea. The patient complained of abdominal pain, fever and chills upon admission to the Emergency Department. Marked decreases in white blood cells and procalcitonin (PCT) were observed after the patient received continuous renal replacement and extracorporeal membrane oxygenation. Plasma cfDNA levels were consistently high, peaking at 1366.40 ng/mL, as measured by a duplex real-time PCR assay with an internal control, which was developed as a novel method for the accurate quantification of cfDNA. The patient died of septic shock on HD 8, suggesting that cfDNA could be used to monitor disease progression more effectively than PCT and the other inflammatory factors measured in this case.

Conclusion: CfDNA may be a promising marker that complements other inflammatory factors to monitor disease progression in patients with septic shock.

Keywords: Acinetobacter baumannii; Case report; Cell-free DNA; Septic shock.

Figure 1

The peripheral blood smear showed a left shift of neutrophil nuclei, prominent toxic granulations and vacuolation in the neutrophil cytoplasm (see arrows) (Wright stain ×1000).

Figure 2

Computed tomography scan. A: Head computed tomography (CT) scan; B: Multislice CT chest scan, showing little interstitial change in the lower lung; C: An abdominal CT scan suggested cardiac dysfunction with pulmonary edema.

Figure 3

Plasma cell-free DNA concentrations. cfDNA: Cell-free DNA; HD: Day of hospitalization.

Figure 4

The bone marrow smear showed granulocyte maturation disorders. A-D: Bone marrow smear. Wright stain ×1000.