Predictive value of serum NETs-related markers for multiple organ dysfunction in patients with septic shock
Chen Nie
Zhao Shuyue
Yang Dejian
Yan Dong
Dai Zhonghong
Abstract：Objective To investigate the characteristics of serum neutrophil extracellular traps(NETs)in patients with septic shock and their predictive value for the risk of developing multiple organ dysfunction syndrome(MODS).Meth-ods This prospective observational study included 212 patients with septic shock treated at our hospital between May 2023 and May 2025.The patients were divided into a MODS group and a non-MODS group based on whether MODS occurred during hospitalization.Basic clinical characteristics,septic shock features,treatment details,and serum NETs markers at admis-sion were collected and compared between the two groups.Multivariate logistic regression analysis was used to identify inde-pendent factors associated with MODS in septic shock patients.The predictive efficacy of individual and combined NETs markers for MODS in septic shock patients was evaluated using receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results The MODS group had higher age,proportion of diabetes comorbidity,proportion of mixed infections,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores at the first diagnosis of septic shock after admission,Sequential Organ Failure Assessment(SOFA)scores,and serum levels of circulating free DNA(cfDNA),citrulli-nated histone H3(CitH3),myeloperoxidase(MPO),and neutrophil elastase(NE)compared to the non-MODS group(t/x2/P=2.342/0.020,4.707/0.030,4.222/＜0.001,5.131/＜0.001,3.630/＜0.001,3.512/0.001,3.728/＜0.001,3.210/0.002).Diabetes comor-bidity,mixed infections,higher APACHE Ⅱ scores,higher SOFA scores,and elevated serum levels of cfDNA,CitH3,MPO,and NE were identified as risk factors for MODS in septic shock patients[OR(95％CI)=2.187(1.007-4.750),2.123(1.031-4.373),1.178(1.055-1.315),1.615(1.226-2.127),1.010(1.001-1.020),1.035(1.014-1.056),1.045(1.022-1.067),1.012(1.004-1.035)].The AUCs for serum cfDNA,CitH3,MPO,NE,and their combination in predicting MODS risk in septic shock patients were 0.628,0.642,0.610,0.600,and 0.806,respectively.The combined prediction of the four NETs markers demonstrated the highest efficacy(Z=4.056,3.816,4.720,4.814,all P＜0.001).Conclusion Serum levels of NETs markers,including cfDNA,CitH3,MPO,and NE,are significantly elevated in septic shock patients who develop MODS and are inde-pendent risk factors for MODS.The combined detection of NETs markers provides a new approach for the early clinical pre-diction of MODS risk in septic shock patients.
Keywords：Septic shockMultiple organ dysfunction syndromeNeutrophil extracellular trapsPrognostic value
Publication Date：2026-03-18
Online Publishing Date：2026-04-08(First online date of this platform, not the publication date of the document)
Pages：6( 298-303 )