Expression of soluble triggering receptor expressed on myeloid cells-1 in septic patients and its relation with prognosis

Abstract

To approach the relationship between the contents of soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) and prognosis in patients with sepsis. Using prospective, control study design, a total of 50 patients with sepsis who were admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University from March to December in the year of 2009 were enrolled. Firstly, the patients were divided into sepsis (n=28) and severe sepsis (n=22) groups according to the patients' condition. Then the patients were divided into survival group (n=34) and death group (n=16) according to the clinical outcome at 28 days after onset of sepsis. Clinical and laboratory data including blood routine tests, blood chemistry, blood gas analysis, C-reactive protein (CRP) and procalcitonin (PCT) were collected on the 1st, 3rd and 7th day after onset. Acute physiology and chronic health evaluation II (APACHEII) score was determined. sTREM-1 levels were determined using enzyme linked immunosorbent assay (ELISA) method. Correlation analysis of the sTREM-1, APACHEII score, white blood cell count (WBC) and CRP, using Logistic regression analysis. A total of 30 healthy persons were enrolled into the control group. The sTREM-1 levels (ng/L) in 50 septic patients on the 1st day were higher than those of the healthy persons (52.80±9.30 vs. 23.29±6.22, P<0.01). The sTREM-1 levels (ng/L) in severe sepsis group on the 1st, 3rd and 7th day (58.25±10.59, 65.75±13.57, 50.18±21.73) were higher than those of the sepsis group (48.55±5.20, 42.85±8.54, 34.02±12.86, P<0.05 or P<0.01). The sTREM-1 levels (ng/L) of the survival group on the 1st, 3rd and 7th day (53.07±10.47, 45.04±9.89, 32.84±8.42) were decreased with the progression of the ailment. The sTREM-1 levels did not differ significantly between the control group and survival group on the 7th day (P>0.05). The sTREM-1 levels (ng/L) in the death group on the 1st, 3rd and 7th day were increased with the progression of the ailment (52.27±6.42, 69.67±12.83, 75.70±10.55), and the level was significantly higher than that in survival group on the 3rd and 7th day (both P<0.01). The contents of sTREM-1 were positive correlated with APACHEII score (r=0.657, P<0.01), but not correlated with WBC (r=0.023, P>0.05), while somewhat correlated with CRP (r=0.150, P<0.10). Logistic regression analysis showed that sTREM-1 [odds ratio (OR)=0.893,P=0.000] and APACHEII score (OR=0.771, P=0.000) might be potential prognostic factors for septic patients. The area under the receiver operator characteristic curve was 0.868 and 0.930. The sensitivity of prognostic evaluation was 81.1% and specificity was 74.5% with sTREM-1 50 ng/L, and the sensitivity was 83.8% and specificity was 86.3% with APACHEII score 20 to estimate the outcome. The serum sTREM-1 are elevated at early stage in sepsis patients. It can reflect the severity of the condition. The sTREM-1 level, which might be considered as a potential prognostic factor for septic patients, is significantly correlated with APACHEII score.