The Prognostic Value of Serum Soluble TREM-1 on Outcome in Adult Patients with Sepsis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Clinical Protocol
2.3. Collection and Processing of Basic Laboratory Tests
2.4. Assay for the sTREM-1 and Biomarkers for Endothelial Dysfunction
2.5. Outcome Analysis
2.6. Statistical Analysis
3. Results
3.1. Characteristics of Patients and Healthy Control
3.2. Correlation Analysis between sTREM-1 and Biomarkers for Endothelial Dysfunction, and Clinical Severity Index
3.3. Comparison of the Characteristics between Survivors and Non-Survivors
3.4. Serial Changes of Serum sTREM-1 Level between Survivor and Non-Survivors
3.5. Prognostic Value of Biomarkers and Clinical Severity Scores on Outcome
3.6. Predictive Ability of sTREM-1 for Septic Shock, Organ Dysfunction, and Bacteremia
4. Discussion
4.1. Major Findings
4.2. The Role of sTREM-1 Levels on Fatality
4.3. Possible Mechanism in This Study
5. Study Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Control | Study Patients | p-Value | |
---|---|---|---|
n = 50 | n = 155 | ||
Age (mean ± SD) | 56.4 ± 12.0 | 64.5 ± 13.8 | NS |
Gender (male%) | 52.9 | 66.5 | NS |
Underlying disease (%) | |||
Diabetes mellitus | 33.4 | 37.4 | NS |
Hypertension | 46.5 | 49.7 | NS |
Coronary artery disease | 8.7 | 9.0 | NS |
Laboratory data (mean ± SD) | |||
White blood cell (109/L) | 5.6 ± 1.6 | 16.1 ± 10.6 | <0.001 * |
Platelet (104/L) | 223.7 ± 61.9 | 182.3 ± 96.6 | <0.001 * |
Hemoglobin (mg/dL) | 14.3 ± 1.9 | 11.8 ± 2.4 | <0.001 * |
C-reactive protein (mg/L) | 1.4 ± 1.3 | 191.3 ± 117.6 | <0.001 * |
sTREM-1 (pg/mL) | 60.4 ± 44.8 | 496.5 ± 382.3 | <0.001 * |
sTREM-1 | ||
---|---|---|
r | p Value | |
ICAM-1 | 0.452 | <0.001 * |
VCAM-1 | 0.337 | <0.001 * |
E-selectin | 0.395 | <0.001 * |
P-selectin | 0.248 | 0.003 * |
lactate | 0.224 | 0.009 * |
APACHE | 0.295 | <0.001 * |
SOFA | 0.340 | <0.001 * |
Survivors (n = 126) | Non-Survivors (n = 29) | p-Value | |
---|---|---|---|
Age (mean ± SD) | 64.0 ± 13.9 | 67.3 ± 13.6 | NS |
Female/Male | 44/82 | 8/21 | NS |
Underlying disease (%) | |||
Diabetes mellitus | 44(34.9%) | 14(48.3%) | NS |
Hypertension | 64(50.8%) | 13(44.8%) | NS |
Liver cirrhosis | 16(12.7%) | 6(20.7%) | NS |
Chronic lung disease | 17(13.5%) | 4(13.8%) | NS |
Stroke | 21(16.7%) | 6(20.7%) | NS |
Coronary artery disease | 12(9.5%) | 2(6.9%) | NS |
Chronic renal disease | 28(22.2%) | 8(27.6%) | NS |
Solid tumor | 19(15.1%) | 9(31.0%) | NS |
Clinical presentation (mean ± SD) a | |||
Systolic blood pressure | 110.2 ± 41.8 | 108.3 ± 39.8 | NS |
Pulse rate | 108.4 ± 24.5 | 112.8 ± 30.0 | NS |
Shock within 24 h | 77(61.1%) | 23(79.3%) | NS |
Respiratory failure within 24 h | 36(28.9%) | 20(69.0%) | <0.001 * |
Disease severity index (mean ± SD) | |||
Maximum 24 h APACHE II score | 18.5 ± 6.9 | 22.8 ± 8.3 | 0.004 * |
Maximum 24 h SOFA score | 5.9 ± 3.2 | 8.4 ± 3.5 | <0.001 * |
Bacteremia | 41(32.5%) | 10(34.5%) | NS |
Steroids use | 36 (28.6%) | 11 (37.9%) | NS |
Inotropic agents use | 42 (33.3%) | 12 (41.3%) | NS |
Inappropiate initial antibiotics | 12 (9.5%) | 2 (6.9%) | NS |
Laboratory data (mean ± SD) a | |||
White blood cell count (109/L) | 15.2 ± 9.9 | 19.8 ± 12.8 | NS |
Neutrophil (%) | 80.8 ± 14.9 | 79.2 ± 17.1 | NS |
Hemoglobin (mg/dL) | 11.9 ± 2.2 | 11.6 ± 3.0 | NS |
Platelet counts (104/L) | 189.7 ± 99.9 | 150.5 ± 74.5 | 0.050 |
C-reactive protein (mg/L) | 195.5 ± 119.5 | 172.9 ± 109.1 | NS |
Lactate (mg/dL) | 30.7 ± 23.2 | 44.6 ± 35.7 | 0.012 * |
Creatinine (mg/dL) | 2.35 ± 2.18 | 3.03 ± 3.73 | NS |
T-bilirubin (mg/dL) | 1.86 ± 2.40 | 2.85 ± 3.50 | NS |
sTREM-1 (pg/mL) | 444.1 ± 348.8 | 732.4 ± 441.7 | <0.001 * |
ICAM-1 (ng/mL) | 701.0 ± 526.8 | 1010.6 ± 638.2 | 0.020 * |
VACM-1 (ng/mL) | 1951.7 ± 1263.7 | 2746.7 ± 1517.0 | 0.004 * |
E-selectin (ng/mL) | 158.7 ± 110.0 | 200.0 ± 124.4 | NS |
P-selectin (ng/mL) | 92.2 ± 28.8 | 101.0 ± 44.2 | NS |
AUC | (95% Confidence Interval) | Cut off Point | Sensitivity | Specificity | |
---|---|---|---|---|---|
TREM-1 | 0.726 * | 0.613~0.838 | 384.6 pg/mL | 0.808 | 0.615 |
ICAM-1 | 0.635 * | 0.510~0.759 | 597 ng/mL | 0.615 | 0.550 |
VCAM-1 | 0.655 * | 0.535~0.774 | 1960 ng/mL | 0.654 | 0.631 |
Lactate | 0.644 * | 0.535~0.752 | 2 mg/dL | 0.857 | 0.325 |
SOFA | 0.705 * | 0.602~0.808 | 6.5 | 0.690 | 0.635 |
APACHE | 0.658 * | 0.548~0.769 | 17.5 | 0.793 | 0.492 |
Case Numbers (n) | TREM-1 Level | AUC | 95% Confidence Interval | |||
---|---|---|---|---|---|---|
Present | Absent | p Value | ||||
Bacteremia | 51 | 613.9 ± 464.3 | 439.1 ± 332.4 | 0.023 * | 0.593 | 0.491~0.696 |
AKI | 59 | 557.7 ± 362.7 | 460.5 ± 390.9 | NS | 0.620 * | 0.526~0.714 |
Septic shock | 100 | 536.8 ± 401.4 | 419.2 ± 333.0 | NS | 0.587 | 0.491~0.682 |
Respiratory failure | 56 | 552.5 ± 411.7 | 463.5 ± 362.2 | NS | 0.567 | 0.468~0.666 |
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Kung, C.-T.; Su, C.-M.; Hsiao, S.-Y.; Chen, F.-C.; Lai, Y.-R.; Huang, C.-C.; Lu, C.-H. The Prognostic Value of Serum Soluble TREM-1 on Outcome in Adult Patients with Sepsis. Diagnostics 2021, 11, 1979. https://doi.org/10.3390/diagnostics11111979
Kung C-T, Su C-M, Hsiao S-Y, Chen F-C, Lai Y-R, Huang C-C, Lu C-H. The Prognostic Value of Serum Soluble TREM-1 on Outcome in Adult Patients with Sepsis. Diagnostics. 2021; 11(11):1979. https://doi.org/10.3390/diagnostics11111979
Chicago/Turabian StyleKung, Chia-Te, Chih-Min Su, Sheng-Yuan Hsiao, Fu-Cheng Chen, Yun-Ru Lai, Chih-Cheng Huang, and Cheng-Hsien Lu. 2021. "The Prognostic Value of Serum Soluble TREM-1 on Outcome in Adult Patients with Sepsis" Diagnostics 11, no. 11: 1979. https://doi.org/10.3390/diagnostics11111979