Plasma DNA and RNA differentially impact coagulation during abdominal sepsis – an explorative study

Abstract Background Cell-free DNA (cfDNA) and extracellular RNA (exRNA) are both suspected to activate coagulation cascades in sepsis. Therefore, our study investigated the influence of plasmatic nucleic acids on coagulation in septic patients in comparison to patients after major abdominal surgery. Material and methods 15 patients with sepsis, 10 postoperative patients and 10 healthy volunteers were included in this longitudinal study. Blood was collected at sepsis onset and after surgery respectively, as well as after 24, 72 and 168 hours. Levels of cfDNA and exRNA were measured by quantitative probe-based PCR. In addition, thromboelastography for coagulation as well as thromboaggregometry for platelet function was conducted. Results Both cfDNA and exRNA were elevated in patients with sepsis compared to postoperative patients and healthy volunteers. While higher exRNA levels correlated with a faster clotting time and more stable clots, cfDNA correlated with a shorter clotting time but also less fibrinolysis. In addition, higher cfDNA seems to be associated with kidney dysfunction as well as with general markers of cell damage (LDH and lactate). Conclusions Both nucleic acid species might be associated with different effects on coagulation during sepsis, with an overall pro-coagulatory influence. For this reason, individualized therapeutic approaches in patients suffering from coagulation-associated organ dysfunction might be feasible.