YU-MIN KUOYEN-CHUN LINLee, Ming JuiMing JuiLeeJENG-WEI CHENHsu, Chih ChiehChih ChiehHsuHuang, Ting YuTing YuHuangChen, Jen HaoJen HaoChenSHIANG-JONG TZENGChiu, Yen LingYen LingChiuWang, Shih RongShih RongWangJEAN-SAN CHIASONG-CHOU HSIEHJung, Chiau JingChiau JingJung2023-01-162023-01-162022-10-0116841182https://scholars.lib.ntu.edu.tw/handle/123456789/627310Background: Neutrophil extracellular traps (NETs) play important roles in sepsis and deep-seated infections, but whether NET formation correlates with clinical outcomes of patients with streptococcal bloodstream infections (BSIs) is unclear. Methods: We analyzed serum levels of complexes of myeloperoxidase and DNA (MPO-DNA) in patients with streptococcal-BSIs. In vitro assay of NET induction by serum from BSI patients was performed. Results: MPO-DNA values for the Streptococci-BSI group (n = 59) were significantly higher than those for healthy controls (p < 0.00001) and matched control groups (n = 59, p = 0.004). The rate of higher MPO-DNA levels (>1.87 μg/mL) were higher in abscess-prone streptococcal groups (streptococcus milleri group) (72.2% vs. 52.5%, p = 0.02). For patients with BSIs due to highly infective endocarditis (IE)-prone pathogens, the values of serum MPO-DNA were also higher in patients diagnosed of IE compared to their counterparts (p = 0.009). Notably, serum from patients with leukopenia could induce higher amounts of in vitro NET formation, despite having low MPO-DNA levels, suggesting that NET formation could be influenced by WBC counts. Therefore, we combined WBC counts with MPO-DNA to predict all-cause 30-day mortality in patients with commensal streptococcal-BSIs. The mortality risk was lowest among patients who had neither high MPO-DNA levels nor abnormal WBC counts (p = 0.058). Furthermore, this group of patients also had a favorable composite outcome consisting of major adverse cardiovascular events (MACE) and all-cause mortality (p = 0.026). Conclusion: Together, these study data suggested that serum MPO-DNA can be a biomarker for predicting a composite outcome consisting of MACE and all-cause mortality in patients with commensal streptococcal-BSIs.enBloodstream infectionCommensal streptococciLeukopeniaMajor adverse cardiovascular eventsNeutrophil extracellular trapsjournal article10.1016/j.jmii.2022.04.009355777362-s2.0-85130372836WOS:000881777400010https://api.elsevier.com/content/abstract/scopus_id/85130372836