Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study

Xingxing Zhao,Zuming Yang,Gen Li,Xing Feng,Bin Sun,Lixiao Xu,Tian Yu,Ying Wang,Tao Pan,Chenxi Feng

doi:10.1186/s12879-020-05196-z

Abstract

BackgroundTo evaluate whether soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) can be used as an early predictor of ventilator-associated pneumonia (VAP).MethodsVentilated neonatal patients admitted into the neonatology department between January 2017 and January 2018 were divided into VAP (n = 30) and non-VAP (n = 30) groups. Serum sTREM, procalcitonin (PCT), C-reactive protein and interleukin-6 levels were measured at 0, 24, 72, and 120 h after initiation of mechanical ventilation (MV). Correlations between blood biomarker concentrations and VAP occurrence were analyzed. Predictive factors for VAP were identified by logistic regression analysis and Hosmer-Lemeshow test, and the predictive value of sTREM-1 and biomarker combinations for VAP was determined by receiver operating characteristic curve analysis.ResultsThe serum sTREM-1 concentration was significantly higher in the VAP group than in the non-VAP group after 72 and 120 h of MV (72 h: 289.5 (179.6–427.0) vs 202.9 (154.8–279.6) pg/ml, P < 0.001; 120 h: 183.9 (119.8–232.1) vs 141.3 (99.8–179.1) pg/ml, P = 0.042). The area under the curve (AUC) for sTREM-1 at 72 h was 0.902 with a sensitivity of 90% and specificity of 77% for the optimal cut-off value of 165.05 pg/ml. Addition of PCT to sTERM-1 at 72 h further improved the predictive value, with this combination having an AUC of 0.971 (95% confidence interval: 0.938–1.000), sensitivity of 0.96, specificity of 0.88, and Youden index of 0.84.ConclusionsTREM-1 is a reliable predictor of VAP in neonates, and combined measurement of serum levels of sTREM-1 and PCT after 72 h of MV provided the most accurate prediction of VAP in neonatal patients.

Highlights

To evaluate whether soluble triggering receptor expressed on myeloid cells-1 can be used as an early predictor of ventilator-associated pneumonia (VAP)
Ventilatorassociated pneumonia (VAP) is one of the most commonly seen complications in neonatal patients [1], and it usually leads to a difficult ventilator weaning, which increases the duration of intensive care unit (ICU) stay [2]
Serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) concentration in neonatal patients with and without VAP After initiation of mechanical ventilation (MV), the serum sTREM-1 concentration was elevated, with peak values observed at 72 h and declining values observed thereafter in both groups (Fig. 1a)

Summary

Introduction

To evaluate whether soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) can be used as an early predictor of ventilator-associated pneumonia (VAP). The serum IL6 concentration was shown to be correlated with the severity of VAP but with limited predictive value based on the finding that IL-6 levels in serum and bronchoalveolar lavage fluid (BALF) did not differ significantly between patients with and without VAP [15] Studies of these biomarkers have provided important information regarding their value in VAP, the dynamic changes in the levels of these inflammatory biomarkers in neonates receiving mechanical ventilation (MV) have not been fully discovered and the possibility that a combination of these biomarkers could provide improved diagnostic or prognostic power in VAP has yet to be explored

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