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Dwivedi et al. Critical Care 2012, 16:R151 http://ccforum.com/content/16/4/RRESEARCHOpen AccessPrognostic utility and characterization of cell-free DNA in patients with severe sepsisDhruva J Dwivedi1,7, Lisa J Toltl2,7, Laura L Swystun2,7, Janice Pogue3,4, Kao-Lee Liaw5, Jeffrey I Weitz1,7, Deborah J Cook1,3,6, Alison E Fox-Robichaud1,7 and Patricia C Liaw1,7*, for the Canadian Critical Care Translational Biology GroupAbstractIntroduction: Although sepsis is the leading cause of death in noncoronary critically ill patients, identification of patients at high risk of death remains a challenge. In this study, we examined the incremental usefulness of adding multiple biomarkers to clinical scoring systems for predicting intensive care unit (ICU) mortality in patients PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/18218841 with severe sepsis. Methods: This retrospective observational study used stored plasma samples obtained from 80 severe sepsis patients recruited at three tertiary hospital ICUs in Hamilton, Ontario, Canada. Clinical data and plasma samples were obtained at study inclusion for all 80 patients, and then daily for 1 week, and weekly thereafter for a subset of 50 patients. Plasma levels of cell-free DNA (cfDNA), interleukin 6 (IL-6), thrombin, and protein C were measured and compared with clinical characteristics, including the primary outcome of ICU mortality and morbidity measured with the Multiple Organ Dysfunction (MODS) score and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Results: The level of cfDNA in plasma at study inclusion had.