Diagnostic utility of elevated serum soluble triggering receptor expressed on myeloid cells (sTREM)-1 in infected neonates

Objective  

To assess the value of serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for early diagnosis of late-onset sepsis (LOS) in neonates, compared with interleukin-6 (IL-6).     

血清可溶性髓样细胞触发受体-1水平在下呼吸道感染诊断中的意义

目的探讨血清可溶性髓系细胞触发受体-1(sTREM-1)在下呼吸道感染诊断中的意义。方法选择社区获得性肺炎82例和慢性阻塞性肺疾病急性加重期69例作为感染组;以同期无感染的患者42例作为非感染组;以同期健康体检者30例为健康对照组。患者入院时检测血常规,测定红细胞沉降率(ESR),留取血清标本,酶联免疫吸附法(ELISA)检测sTREM-1水平。结果感染组sTREM-1水平、ESR、白细胞计数(WBC)和中性粒细胞百分比(N)均高于健康对照组,差异有统计学意义(P<0.05);感染组WBC、N和sTREM-1水平均高于非感染组,差异有统计学意义(P<0.05);非感染组sTREM-1水平、ESR高于健康对照组,差异有统计学意义(P<0.05)。结论血清sTREM-1水平可以作为下呼吸道感染诊断的参考指标。     

Time-course of sTREM (soluble triggering receptor expressed on myeloid cells)-1, procalcitonin, and C-reactive protein plasma concentrations during sepsis

OBJECTIVE: To describe the course of plasma sTREM (soluble triggering receptor expressed on myeloid cells)-1, procalcitonin (PCT), and C-reactive protein (CRP) concentrations during sepsis and their clinical informative value in predicting outcome. DESIGN: Prospective, noninterventional study. SETTING: Medical adult intensive care unit at a university hospital in France. PATIENTS: Sixty-three critically ill patients with sepsis, severe sepsis, or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Soluble TREM-1 concentrations were significantly lower at admission in nonsurvivors (n = 21) than in survivors (n = 42) (94 [30-258] vs. 154 [52-435] pg/mL, p = .02), whereas PCT levels were higher among nonsurvivors (19.2 [0.3-179] vs. 2.4 (0-254) pg/mL, p = .001). CRP levels did not differ between the two groups of patients. Plasma PCT and CRP decreased during the 14-day period of study in both survivors and nonsurvivors. Conversely, sTREM-1 plasma concentrations remained stable or even increased in nonsurviving patients and decreased in survivors. An elevated baseline sTREM-1 level was found to be an independent protective factor with an odds of dying of 0.1 (95% confidence interval, 0.1-0.8). CONCLUSION: A progressive decline of plasma sTREM-1 concentration indicates a favorable clinical evolution during the recovery phase of sepsis. In addition, baseline sTREM-1 level may prove useful in predicting outcome of septic patients.     

血清可溶性髓系细胞触发受体-1检测在细菌性肺炎诊断中的意义

目的:检测细菌性肺炎患者外周血可溶性髓系细胞触发受体-1(sTREM-1)的水平,观察sTREM-1对诊断细菌性肺炎的意义。方法:应用双抗体夹心酶联免疫吸附法(ELISA)检测75例细菌性肺炎患者及72例正常健康体检者血清sTREM-1、降钙素原(PCT)、C反应蛋白(CRP)的水平。应用受试者工作特征(ROC)曲线研究sTREM-1的诊断效力。对肺炎组进一步进行亚组分析,并将sTREM-1水平与临床肺部感染评分(CPIS)进行相关性分析。结果:细菌性肺炎患者血清sTREM-1水平为(9.89±6.13)ng/mL,较对照组[(3.37±1.67)ng/mL]显著升高(P=0.001)。根据ROC曲线,sTREM-1取>4.46ng/mL为临界值,其曲线下面积为0.811,诊断细菌性肺炎的灵敏度为70.7%,特异度为76.4%,阳性预测值为75.7%,阴性预测值为71.4%,准确率为73.5%,诊断效能中等。肺炎组中重症肺炎患者血清sTREM-1为(12.65±6.37)ng/mL,较非重症患者[(9.14±5.91)ng/mL]水平增高,差异有统计学意义(P<0.05)。肺炎组患者sTREM-1水平与CPIS评分呈正相关(P<0.05)。结论:测定细菌性肺炎患者血清sTREM-1水平对于细菌性肺炎的诊断有一定价值。重症肺炎患者血清sTREM-1水平升高,且与CPIS评分相关,提示sTREM-1与感染严重程度相关。     

Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia

Objectives

The purpose of this study is to investigate the clinical use of inflammatory marker triggering receptor expressed on myeloid cells (TREM)-1 at admission for differentiating between typical and atypical bacterial community-acquired pneumonia (CAP).

Methods

A prospective, noninterventional study of patients with CAP hospitalized through the emergency department was performed. Surface expression of TREM-1 was analyzed using flow cytometry on peripheral blood cells, and soluble TREM-1 (sTREM-1) concentration was determined in plasma.

Results

Eighty-eight patients with clinical suspicion of CAP were eligible. The causative pathogen was identified in 39 patients (44.3%). After excluding 4 mixed pneumonia cases, 21 typical and 14 atypical bacterial infections were enrolled. Patients with typical bacterial CAP demonstrated increased TREM-1 surface expression on monocytes and neutrophils. Median plasma sTREM-1 levels at admission were 65.2 pg/mL (range, 17.6-138.1 pg/mL) in patients with typical CAP and 25.9 pg/mL (range, 11.5-54.8 pg/mL) in patients with atypical CAP (P < .001). Soluble TREM-1 had good discriminative value to differentiate typical from atypical pathogens with an area under the receiver operating characteristic curve of 0.87 (95% confidence interval, 0.75-0.98). At a cutoff level of 44.2 pg/mL, sTREM-1 yielded a sensitivity of 81%, a specificity of 79%, a positive likelihood ratio of 3.79, and a negative likelihood ratio of 0.24.

Conclusions

In newly admitted patients with CAP, determination of the TREM-1 levels may provide useful additional diagnostic information on the bacterial etiology.     

Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia

Objective To determine the diagnostic role of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in non-directed bronchial lavage fluid in ventilator-associated pneumonia (VAP).Design Non-directed bronchial lavage fluid and plasma were collected on alternate days in critically ill mechanically ventilated patients from the start of ventilatory support until complete weaning from the ventilator. Soluble TREM-1 levels were measured by an enzyme-linked immunosorbent assay.Setting A general adult medical and surgical university hospital intensive care unit.Patients Nine patients who developed VAP and 19 patients who did not develop VAP (controls).Results Plasma levels of sTREM-1 did not change significantly in either patient group. While in controls concentrations of sTREM-1 in non-directed bronchial lavage fluid did not change significantly over time, in patients who developed VAP levels of sTREM-1 in non-directed bronchial lavage fluid increased towards the diagnosis of VAP. A cut-off value for non-directed bronchial lavage fluid sTREM-1 levels of 200 pg/ml on the day of VAP had a diagnostic sensitivity of 75% and a specificity of 84%. Sensitivity increased when taking into account all sTREM-1 levels higher than 200 pg/ml from the 6-day period before the day of diagnosis that were preceded by an increase of at least 100 pg/ml (sensitivity 88%, specificity 84%).Conclusions Soluble TREM-1 is a potential biomarker of VAP.     

可溶性髓系细胞触发受体-1对呼吸机相关肺炎早期诊断及预后的判断价值

目的探讨血清及呼出气冷凝液（EVC）中可溶性髓系细胞触发受体-1（sTREM1）对呼吸机相关性肺炎（VAP）早期诊断及预后判断的临床价值。方法对37例机械通气患者进行治疗后评估,分成非感染组13例,感染组24例（其中治疗有效组14例,治疗无效组10例）,所有患者均在机械通气后第1、3、5、7天应用双抗体夹心酶联免疫吸附法（DAS-ELISA）测定血清和EVC中sTREM-1水平,并记录下呼吸道分泌物细菌培养结果和患者治疗后转归;应用受试者工作特征曲线（ROC）研究sTREM-1对VAP早期诊断效能及预后判断价值。结果第1天,血清及EVC中sTREM-1水平治疗有效组、治疗无效组及非感染组比较,差异无统计学意义（P〉0．05）;第3天和第5天,感染组较非感染组有明显升高（P〈（J．01）;第7天,治疗无效组仍处较高水平,与治疗有效组、非感染组比较差异有统计学意义（P〈0．01）,而治疗有效组与非感染组比较差异无统计学意义（P〉0．05）。应用ROC分析,第3天血清和EVC中sTREM-1曲线下面积分别为0．897、0．909。以第3天EVC中sTREM-14．70ng／mL为VAP的早期诊断界值,其诊断灵敏度为95．8％,特异度为92．3％。结论血清和EVC中sTREM-1检测有助于VAP的早期诊断,第7天血清和EVC中sTREM-1水平有助于判断VAP的预后（撤机失败和死亡）,与血清标本比较,EVC的获得更加方便。     

Diagnostic role of soluble triggering receptor expressed on myeloid cell-1 in patients with sepsis

BACKGROUND:

Biomarkers may be helpful in risk stratification and prediction of mortality in septic patients. This study aimed to investigate the diagnostic role of soluble triggering receptor expressed on myeloid cell-1(sTREM-1), procalcitonin (PCT), C-reactive protein (CRP) and other inflammatory markers in patients with sepsis.

METHODS:

A total of 56 patients with systemic inflammation response syndrome (SIRS) who had been admitted to the ICU department of the Second Hospital of Tianjin Medical University between May 2009 and July 2010 were enrolled. They were divided into a sepsis group (n=32) and a SIRS group (n=24). Twenty-five non-SIRS patients served as controls. The sepsis group was sub-divided into a survival group and a death group according to 28-day prognosis. The values of sTREM-1, PCT, CRP, white blood cell (WBC), and neutrophil count percentage (N) were measured. Acute physiology and chronic health evaluation II (APACHE II) score were determined within 24 hours. The correlation between sTREM-1 and APACHE II score was analyzed. Quantitative data were analyzed by the F test or the Kruskal-Wallis test.

RESULTS:

The plasma level of sTREM-1 in the sepsis group was significantly higher than that in the SIRS group and control group. The plasma level of sTREM-1 in the non-survival group was significantly higher than that in the survival group. In the sepsis group, the plasma sTREM-1 level was positively correlated with APACHE II score (r=0.426, P= 0.032). The area under the ROC curve of sTREM-1 was 0.935, larger than that of PCT and CRP.

CONCLUSION:

Plasma sTREM-1 is useful in the diagnosis of sepsis at early stage. The increased level of sTREM-1 during the first 24 hours may be correlated with poor outcome of patients with sepsis.KEY WORDS: Sepsis, sTREM-1, Acute physiology and chronic health evaluation II score, Enzyme-linked immunosorbent assay, Procalcitonin, C-reactive protein     

Increased plasma levels of soluble triggering receptor expressed on myeloid cells 1 and procalcitonin after cardiac surgery and cardiac arrest without infection

Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) and procalcitonin (PCT) are often considered to be specific markers for infection. We evaluated plasma levels of sTREM-1 and PCT in patients with systemic inflammatory response syndrome but no sepsis. Noninfected patients undergoing elective heart surgery with cardiopulmonary bypass (n = 76) and patients admitted after out-of-hospital cardiac arrest (n = 54) were followed up for 3 days. Patients with severe sepsis (n = 55) and healthy volunteers (n = 31) were included as positive and negative controls, respectively. Plasma levels of PCT were higher in sepsis patients than in patients who survived after cardiac arrest or after heart surgery. In contrast, peak plasma levels of sTREM-1 in heart surgery and in cardiac arrest patients overlapped with those measured in patients with sepsis. Both sTREM-1 and PCT were significantly higher in cardiac arrest patients who died of refractory shock than in those who died of neurological failure or survived without major neurological damage. In the cardiac arrest patients with refractory shock, sTREM-1 and PCT levels were similar to those in the patients with severe sepsis. In conclusion, sTREM-1 and PCT are not specific for infection and can increase markedly in acute inflammation without infection.     

Surface triggering receptor expressed on myeloid cells 1 expression patterns in septic shock

Objective To analyze the pattern of cell-surface expression of the triggering receptor expressed on myeloid cells (TREM) 1 during septic shock.Design and setting Prospective clinical study in an adult 16-bed medical ICU.Patients and methods 25 septic shock patients, 15 patients with shock of noninfectious origin and 7 healthy volunteers. Arterial blood was drawn within 12 h of admission and subjected to flow cytometry analysis after staining with anti-TREM-1 and anti-CD14 antibodies. Repeated sampling was performed on days 2, 3, 5, 7, and 14 in septic shock patients.Results Monocytic TREM-1 expression was significantly higher in septic shock patients (mean fluorescence intensity 2.3±0.2) than in nonseptic patients (1.0±0.1), and healthy volunteers (1.0±0.1). There was no difference in monocytic TREM-1 expression between nonseptic patients and healthy volunteers or between any of the three groups with respect to TREM-1 expression on neutrophils. The time course of TREM-1 expression on monocytes diverged significantly by day 3 between survivors and ns.Conclusions The specificity of TREM-1 regulation by infection is highlighted. Moreover, surface TREM-1 expression on monocytes may prove useful in allowing the follow-up of septic patients during the course of the diseaseElectronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

胸腔积液可溶性髓系细胞触发受体1水平及意义

目的 探讨各种病因所致胸腔积液可溶性髓系细胞触发受体1(sTREM-1)的水平及意义.方法 分别收集细菌性胸腔积液(n=12)、结核性胸腔积液(n=31)、恶性肿瘤胸腔积液(n=35)和漏出液(n=15)患者的胸水和外周血标本,采用酶联免疫吸附测定法检测胸水和血清中sTREM-1的浓度.结果 4种类型的胸腔积液其胸水sTREM-1浓度均高于血清sTREM-l浓度(P＜0.05或＜0.01).细菌性胸腔积液其胸水和血清sTREM-l浓度均明显高于结核性胸腔积液、恶性肿瘤胸腔积液和漏出液,胸水sTREM-1[M(QR)]2 616.9(2 096.8)ng/L vs 286.0(348.0)ng/L、496.8(1 160.5)ng/L、102.3(266.5)ng/L(P＜0.01),血清sTREM-1 38.1(28.1)ng/L vs 0.2(19.8)ng/L、0.0(14.3)ng/L、15.7(67.6)ng/L(P＜0.01).结论 胸膜疾病胸腔积液TREM-1表达水平增高,以胸膜细菌感染时增高最明显,胸水sTREM-1浓度可以作为判断细菌感染的参考指标.     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

目的 观察脓毒症患者血浆可溶性髓系细胞表达的触发受体-1(sTREM-1)动态变化,探讨其与感染相关器官功能衰竭评分系统(SOFA)评分对预后的评价.方法 采用前瞻性随机对照研究.选择2009年5月至2010年6月天津医科大学第二医院重症监护病房(ICU)收治的32例脓毒症患者,根据28 d转归分为生存组(21例)和死亡组(11例),检测患者入院后1、3、7 d的血小板计数(PLT),并进行SOFA评分;采用酶联免疫吸附法(ELISA)检测血浆sTREM-1浓度.以同期25例健康体检者作为对照.结果 对照组PLT为(248.88±48.62)×109/L,sTREM-1为25.7(21.5,53.3)ng/L.脓毒症死亡组PLT(×109/L)1 d时即明显下降,且随病情进展呈下降趋势(1、3、7 d分别为95.77±47.42、91.92±35.78、82.31±31.04),SOFA评分(分)亦随之下降(1、3、7 d分别为12.36±4.30、10.90±5.32、7.87±4.60),sTREM-1(ng/L)1 d时即明显升高,且随病程进展呈上升趋势[1、3、7 d分别为360.5(262.2,434.5)、373.5(263.1,495.6)、496.6(380.0,571.8)3;生存组PLT(×109/L)3 d时降低后有所升高(1、3、7 d分别为152.94±85.59、136.18±75.30、165.41±61.36),SOFA评分(分)则逐渐下降(1、3、7 d分别为6.76±2.71、4.29±2.31、2.52±1.03),sTREM-1(ng/L)峰值出现在1 d时,然后随病程进展逐渐下降[1、3、7 d分别为204.1(175.0,269.6)、164.0(145.9,194.2)、81.5(62.1,109.0)].与生存组比较,死亡组各时间点PLT明显下降,SOFA评分、sTREM-1明显升高(P＜0.05或P＜0.01).血浆sTREM-1水平与PLT呈显著负相关(r=-0.257,P=0.042),与SOFA评分呈显著正相关(r=0.736,P=0.002).结论 脓毒症患者sTREM-1水平在发病早期即明显升高,其动态变化联合SOFA评分可能更有助于判断预后.

Abstract：

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

可溶性髓系细胞触发受体-1在细菌性脑膜炎诊断中的意义

目的探讨脑脊液中可溶性髓系细胞触发受体-1(sTREM-1)在细菌性脑膜炎中的诊断意义。方法应用定量酶联免疫吸附法(ELISA)检测脑脊液sTREM-1水平,应用免疫发光法和免疫浊度法分别检测血液中降钙素原(PCT)、C反应蛋白(CRP)水平。应用受试者工作特征ROC曲线研究sTREM-1的诊断效能。结果细菌性脑膜炎组脑脊液sTREM-1水平较病毒性脑膜炎组和对照组显著升高(P<0.05),病毒性脑膜炎组和对照组比较差异无统计学意义(P>0.05)。根据ROC曲线,取sTREM-1>25 ng/L为临界值,其曲线下面积为0.930,诊断细菌性脑膜炎的灵敏度为90.0%、特异度为93.5%、准确率为93.8%,诊断效能好。结论测定脑脊液sTREM-1水平对于细菌性脑膜炎的诊断有一定价值。     

可溶性髓细胞触发受体-1对伴肺部渗出脓毒症患者的临床价值

目的检测新入ICU患者血清和肺泡灌洗液可溶性髓细胞触发受体-1（sTREM-1）,探讨sTREM-1在伴肺部渗出的脓毒症（ sepsis ）患者中的变化及意义。方法选择我院ICU 2012-09～2013-09收治的伴有肺部渗出及全身炎症反应综合征（ SIRS）的机械通气患者70例作为试验组,根据其临床特点及病原学检测结果,分为脓毒症组39例,非感染性SIRS组31例。两组在入院的第1、4、7天和第1、4天分别收集血清和肺泡灌洗液（ BALF）标本,同期纳入血清对照组30例,BALF对照组35例。采用酶联免疫吸附试验（ELISA）测定sTREM-1质量浓度,比较不同部位sTREM-1质量浓度与同期检测各种生物标志物对脓毒症的诊断及预后判断参数。结果①入院第1天脓毒症组血清sTREM-1质量浓度[425.20（653．72）pg/mL],与血清对照组（84.33±24．03）pg/mL及SIRS组[99．74（67．54）pg/mL]比较差异均有统计学意义（P＜0．01）;②入院第1天区分脓毒症与SIRS诊断的各参数ROC曲线下面积（ AUC）依次为血清sTREM-1（0．796）、CRP（0．668）,而入院第4天两组比较仅血清 sTREM -1差异有统计学意义（P ＝0.001）,其AUC为0．837;③各时间点脓毒症死亡组血清sTREM-1质量浓度均显著高于生存组（P＜0．05）,其中入院第1天判断脓毒症组预后各参数AUC依次为血清sTREM-1（0．792）、SOFA评分（0．756）;入院第4天依次为 SOFA 评分（0．801）、APACHEⅡ评分（0．757）、血清sTREM-1（0．696）;入院第7天依次为APACHEⅡ评分（0．835）、血清sTREM-1（0．725）;④入院第1、4及7天脓毒症生存组肺泡灌洗液sTREM-1质量浓度分别为（99．22±129．94,204．67±147．42,169．51±157．04）pg/mL,差异有统计学意义（P＝0．001）,而脓毒症死亡组不同时间点间比较差异无统计学意义（P＞0．05）。结论血清sTREM-1在伴有肺部渗出的脓毒症患者中呈高表达,显著高于SIRS患者及健康人群,其在脓毒症早期具有优于其他标志物的诊断与判断预后的能力,且肺泡灌洗液sTREM-1在病程后期下降,提示预后良好。     

Soluble triggering receptor expressed on myeloid cells 1 and the diagnosis of sepsis

Purpose

Early diagnosis and assessment of the systemic inflammatory response to infection are difficult with usual markers (fever, leukocytosis, C-reactive protein [CRP]). Triggering receptor expressed on myeloid cells-1 (TREM-1) expression on phagocytes is up-regulated by microbial products. We studied the ability of soluble TREM-1 (sTREM-1) to identify patients with sepsis.

Materials and Methods

Plasma samples were obtained on intensive care unit admission from patients with systemic inflammatory response syndrome for sTREM-1 measurement.

Results

Soluble TREM-1, CRP concentrations and erythrocyte sedimentation rate (ESR) were higher in the sepsis group (n = 52) than in the non-infectious systemic inflammatory response syndrome group (n = 43; P = .00, .02, and .001, respectively). Soluble TREM-1, CRP concentrations, white blood cell count and ESR were higher in the sepsis group than in the non SIRS group (n = 37; P = .04, .00, .01, and .00, respectively).In a receiver-operating characteristic curve analysis, ESR, CRP and sTREM-1 had an area under the curve larger than 0.65 (P = .00), in distinguishing between septic and non-infectious SIRS patients. CRP, ESR, sTREM-1 had a sensitivity of 60%, 70% and 70% and a specificity of 60%, 69% and, 60% respectively in diagnosing infection in SIRS.

Conclusion

C-reactive protein and ESR performed better than sTREM-1 and white blood cell count in diagnosing infection.