Clinical value of soluble triggering receptor expressed on myeloid cells-1(sTREM-1) in severe sepsis patients with pulmonary infiltrates

YANG Jun-jie; HUANG Yun-fei; WU Hong-cheng

doi:10.3969/j.issn.1002-1949.2014.11.003

Abstract：Objective To detect the serum and Broncho alveolar lavage fluid (BALF) levels of soluble triggering receptor expressed on myeloid cells -1 ( sTREM -1 ) so as to investigate the significance of sTREM-1 in sepsis patients with pulmonary infiltrates.Methods Seventy ICU patients with pulmonary infiltrates and systemic inflammatory response syndrome ( SIRS ) were enrolled in test group from September 2012 to September 2013.According to the clinical features and results of the pathogens, the patients were divided into two subgroups:39 with sepsis, 31with SIRS.BALF and blood samples were collected on day 1, 4, 7 in sepsis group and day 1, 4 in SIRS group.Thirty normal subjects and 35 patients without SIRS from Department of Respiratory Medicine served as serum and BALF controls.Levels of sTREM-1 was measured by enzyme-linked immunosorbent assay ( ELISA) . The early diagnostic and prognostic value was assessed by receiver operating characteristic ( ROC) curve analysis.Results ①The levels of BALF sTREM-1 in sepsis group on day 1 [425.20 (653.72) pg/mL] were significantly higher than those in serum controls (84.33 ±24.03 pgm/L) and in SIRS group [99.74 (67.54) pg/mL] (P<0.01).②The area under the curve (AUC) in ROC of ssTREM-1 and CRP for the diagnosis of sepsis were 0.796 and 0.668 on day 1, while only ssTREM-1 with 0.837 on day 4.③ ssTREM-1 levels were significantly higher in the non-survivor than in the survivor group at each time point;the AUC in ROC of ssTREM-1 and SOFA for the prognosis of sepsis survive were 0.792 and 0.756 on day 1;SOFA, APACHEⅡand ssTREM-1 were 0.801, 0.757 and 0.696 on day 4, while APACHEⅡand ssTREM -1 were 0.835 and 0.725 on day 7.④There was a significant difference between the levels of BALF sTREM -1 in survivors in sepsis group on day 1, 4 and 7 (99.22 ±129.94, 204.67 ±147.42, 169.51 ±157.04) pg/mL (P=0.001), while no significant difference between non-survivors.Con clusion The sTREM-1 has high expression level in serum in sepsis patients with pulmonary infiltrates.This suggests it may be a mild index for sepsis diagnosis and prognosis judgment, better than other clinical biomarkers in early stage.The decline of sTREM-1 in BALF is associated with favorable prognosis.