The identification of reliable outcome predictors in severe sepsis is vital for (Point of Care) POC Diagnosis and Prognosis, and for stratifying patients onto various treatment regimes. Our preliminary studies have demonstrated that the measurement of novel biomarkers can predict mortality, sepsis and multi-organ failure (MOF) in patients with traumatic and thermal injury. These include IG on a full blood counter, Neutrophil Extracellular Traps (NETs) and procoagulant microvesicles. In the Golden Hour study (in Traumatic Brain Injury (TBI) and Orthopaedic Injury), collection of blood samples less than 1 hour after injury reveals that there are many significant early changes in these markers in relation to outcomes and shows the potential importance of very early pre-hospital measurements. The rapid measurement of cfDNA shows that this can be potentially derived from a number of sources including the injured tissue, NETs, infections and major organs during MOF. Quantitative PCR measurements demonstrate that the majority of cfDNA originates from the nucleus and not the mitochondria. Measurement of the specific NETs marker: CitH3, also suggests that neutrophils are also releasing cfDNA. Determination of the exact quantity and source(s) of cfDNA would therefore be very useful for not only confirming the tissue(s) or cells of origin but assessing the degree of injury to a tissue.
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