Utility of cell-free DNA concentrations and illness severity scores to predict survival in critically ill neonatal foals.
Authors: Colmer Sarah Florence, Luethy Daniela, Abraham Michelle, Stefanovski Darko, Hurcombe Samuel David
Journal: PloS one
Summary
# Editorial Summary: Cell-free DNA in Critically Ill Foals Whilst plasma cell-free DNA (cfDNA) has shown promise as a prognostic marker in septic humans and dogs, its clinical utility in equine neonates remained unknown. Colmer and colleagues prospectively evaluated 80 foals aged ≤10 days—stratified as healthy (n=34), sick non-septic (n=11), or septic (n=35)—measuring cfDNA concentrations alongside established illness severity scoring systems (sepsis score and neonatal SIRS score) to determine their predictive value for survival. Despite detecting cfDNA in all foals, the researchers found no significant differences in plasma concentrations between healthy and diseased groups, nor any correlation between cfDNA levels and sepsis status, blood culture results, or survival outcomes; by contrast, both sepsis score (AUC 0.85) and NSIRS score (AUC 0.83) demonstrated substantially superior prognostic accuracy compared to cfDNA (AUC 0.64). These findings suggest that whilst cfDNA is present in neonatal foal plasma, it offers negligible clinical value for either diagnosing sepsis or stratifying mortality risk in critically ill foals, and practitioners should continue to rely on established clinical and laboratory scoring systems rather than cfDNA quantification when assessing prognosis in hospitalised neonates.
Read the full abstract on PubMed
Practical Takeaways
- •Do not rely on plasma cfDNA as a diagnostic marker for sepsis or a prognostic indicator in sick neonatal foals—traditional sepsis and NSIRS scoring systems are far more clinically useful.
- •Continue using established sepsis score and neonatal SIRS score protocols for risk stratification and survival prediction in critically ill foals under 10 days of age.
- •cfDNA testing offers no practical advantage over clinical assessment tools already validated for equine neonatal critical care.
Key Findings
- •Plasma cell-free DNA (cfDNA) was detectable in all 80 foals studied, but showed no significant differences between healthy, sick non-septic, and septic groups (P = 0.65 and P = 0.88 respectively).
- •cfDNA concentrations were not significantly associated with blood culture status, sepsis score, NSIRS score, or foal survival.
- •Sepsis score (AUC 0.85) and neonatal SIRS score (AUC 0.83) were substantially superior to cfDNA (AUC 0.64) for predicting survival in critically ill neonatal foals.