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Circulating cell-free DNA (cf-DNA) mainly comes fromapoptotic cells and can refl ect the extent of cellulardamage. Increased plasma levels of cf-DNA have beenfound in many acute disorders, including septic andclinically ill patients, and usually correlate well withclinical outcome. Acute respiratory failure, the mostfrequent organ failure in ICU patients, can be related tovarious acute diseases that may cause cell death andrelease of DNA into the bloodstream. In a recent issueof Critical Care, Okkonen and colleagues evaluate levelsof cf-DNA in plasma as a prognostic marker in patientsneeding mechanical ventilation. They report thatplasma cf-DNA was higher than normal in patients withmechanical ventilation, and even higher in patientswho eventually died compared to survivors. However,its usefulness as a death predictor may be limited inthe heterogeneous group of mechanically ventilatedpatients, probably due to confounding eff ects of comorbidities,among other factors

Diagnostic potential of circulating cell-free DNA in patients needing mechanical ventilation: promises and challenges