Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock.

Juan-Jesús Ríos-Toro,Ricardo Rivera-Fernández,José-Antonio Girón-González,Andrés Martín-Aspas,Ana Sáez De Benito,José-María García-Álvarez,Mercedes Márquez-Coello,Chiara Lazzeri

doi:10.1371/journal.pone.0175254

Abstract

BackgroundThe objective of this study was to explore the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cell 1 (sTREM-1), soluble cluster of differentiation 14 (sCD14), soluble cluster of differentiation 163 (sCD163), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for patients with severe sepsis and septic shock in an intensive care unit (ICU).MethodsFifty patients admitted at the ICU with the diagnosis of severe sepsis or septic shock were studied. SOFA and APACHE II scores as well as serum biomarkers were measured at days 0, 2 and 5. The influence of these variables on 28-day mortality was analyzed. Twenty healthy individuals served as controls.ResultsBaseline serum concentrations of sTREM-1, sCD163, IL-6 and PCT correlated with SOFA score. Only sTREM-1 levels correlated with APACHE II score. The 28-day mortality rate for all patients was 42%. The absence of risk factors for infection, presence of septic shock, baseline values of sCD14 and decrease of PCT and IL-6 from baseline to day 5 were variables associated to mortality in the univariate analysis. The unique independent factor associated to mortality in the multivariate analysis was a decrease of PCT higher than 50% from days 0 to 5.ConclusionsSerum levels of sTREM-1 are correlated with the severity of sepsis. A 50% decrease of PCT was the unique variable associated with survival in the multivariate analysis.

Highlights

Sepsis is an important medical problem with significant morbidity and mortality [1]
Baseline serum concentrations of sTREM-1, soluble cluster of differentiation 163 (sCD163), IL-6 and PCT correlated with SOFA score
STREM-1 levels correlated with APACHE acute physiology and chronic health evaluation (II) score

Summary

Introduction

Sepsis is an important medical problem with significant morbidity and mortality [1]. From a clinical perspective, sepsis is defined and diagnosed based on the observation of physiopathological changes in response to an infection, i.e. the interaction between microbes and the human immune system (both innate and acquired), the synthesis of mediators, and the response of the organism [1].During the last decade, much effort has been directed toward the identification of biomarkers that are useful in the differential diagnosis of sepsis and in the prediction of prognosis [2,3,4,5,6,7,8,9,10,11,12,13,14]. It has been demonstrated to play a role in inflammation [8] After interacting with their ligands, these molecules promote the expression of proinflammatory cytokines, such as IL-6, and contribute to the systemic inflammatory response [5]. Each of these molecules can be detected as plasma soluble receptors (sTREM-1, sCD14 or presepsin, sCD163) [9,10,11]. The objective of this study was to explore the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cell 1 (sTREM-1), soluble cluster of differentiation 14 (sCD14), soluble cluster of differentiation 163 (sCD163), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for patients with severe sepsis and septic shock in an intensive care unit (ICU)

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