Elevated Serum Tenascin-C Predicts Mortality in Critically Ill Patients With Multiple Organ Dysfunction

Area of Science:

• Critical Care Medicine
• Biomarkers
• Prognostic Indicators

Background:

• Multiple organ dysfunction syndrome (MODS) is a leading cause of death in critically ill patients.
• Tenascin-C (TNC), a matricellular protein re-expressed after injury, is implicated in tissue repair and inflammation.
• The prognostic role of serum TNC in MODS remains underexplored.

Purpose of the Study:

• To investigate the association between serum Tenascin-C (TNC) levels and 28-day all-cause mortality in critically ill patients with multiple organ dysfunction.
• To evaluate the predictive performance of serum TNC as a prognostic biomarker for mortality in this patient population.

Main Methods:

• Prospective enrollment of adult critically ill patients with at least two organ dysfunctions into derivation (emergency) and validation (inpatient) cohorts.
• Serum TNC levels were measured using ELISA within 24 hours of enrollment.
• Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to assess the association between TNC and mortality, and its predictive value.

Main Results:

• Non-survivors exhibited significantly higher serum TNC levels compared to survivors (467.7 vs. 197.5 ng/ml, p < 0.001).
• Serum TNC independently predicted 28-day mortality, outperforming established scores like SOFA, APACHE II, and SAPS II in ROC analysis (AUC 0.803).
• An optimal cut-off of 298.2 ng/ml demonstrated significant mortality prediction (sensitivity 74.3%, specificity 74.7% in the emergency cohort).

Conclusions:

• Serum TNC is a significant independent predictor of mortality in critically ill patients with multiple organ dysfunction.
• TNC holds promise as a valuable prognostic biomarker for identifying patients at higher risk of death.
• Further research could explore TNC's therapeutic potential or its role in guiding treatment strategies for MODS.