Dynamic changes of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) reflect sepsis severity and can predict prognosis: a prospective study.
Dynamic changes of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) reflect sepsis severity and can predict prognosis: a prospective study.
复制标题
DOI：
10.1186/1471-2334-11-53
复制
发表时间：
2011-03-01
影响因子：
3.7
通讯作者：
Xie L
中科院分区：
文献类型：
--
作者：
Zhang J;She D;Feng D;Jia Y;Xie L
我们检测了骨髓细胞表达的可溶性触发受体-1 （sTREM-1）的血清水平对脓毒症患者的诊断、严重程度评估和预测预后的效用，并将sTREM-1的值与c反应蛋白（CRP）和降钙素原（PCT）的值进行了比较。纳入52例脓毒症患者：脓毒症15例，严重脓毒症（严重脓毒症+感染性休克）37例。在入住ICU后第1、3、5、7、10和14天检测sTREM-1、CRP和PCT的血清水平。严重脓毒症患者血清sTREM-1水平在第1天显著高于脓毒症患者（240.6 pg/ml vs. 118.3 pg/ml; P < 0.01），但CRP和PCT水平在两组间无显著差异。sTREM-1对严重脓毒症患者的ROC曲线下面积为0.823（95%可信区间：0.690-0.957）。以sTREM-1浓度222.5 pg/ml为临界值，敏感性为59.5%，特异性为93.3%，阳性预测值为95.6%，阴性预测值为48.3%，阳性似然比为8.92，阴性似然比为0.434。根据28天的存活率，存活组的sTREM-1水平随着时间的推移呈下降趋势，而非存活组的sTREM-1水平呈逐渐上升趋势。在所有时间点，非存活组的sTREM-1水平均高于存活组，而两组的CRP和PCT水平均随时间下降。sTREM-1水平与顺序器官衰竭评估（SOFA）评分呈正相关（r = 0.443, P < 0.001），且该相关系数大于CRP和PCT的相关系数，血清sTREM-1水平比CRP和PCT更准确反映脓毒症的严重程度，对脓毒症预后的动态评估更敏感。当前对照试验ChiCTR-OCH-09000745
We examined the utility of serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for the diagnoses, severity assessments, and predicting the prognoses of patients with sepsis and compared sTREM-1 values with those of C-reactive protein (CRP) and procalcitonin (PCT). Fifty-two patients with sepsis were included: 15 sepsis cases and 37 severe sepsis cases (severe sepsis + septic shock). Serum levels of sTREM-1, CRP, and PCT were determined on days 1, 3, 5, 7, 10, and 14 after admission to an ICU. Serum sTREM-1 levels of patients with severe sepsis were significantly higher than for those with sepsis on day 1 (240.6 pg/ml vs. 118.3 pg/ml; P < 0.01), but CRP and PCT levels were not significantly different between the two groups. The area under an ROC curve for sTREM-1 for severe sepsis patients was 0.823 (95% confidence interval: 0.690-0.957). Using 222.5 pg/ml of sTREM-1 as the cut-off value, the sensitivity was 59.5%, the specificity was 93.3%, the positive predictive value was 95.6%, the negative predictive value was 48.3%, the positive likelihood ratio was 8.92, and the negative likelihood ratio was 0.434. Based on 28-day survivals, sTREM-1 levels in the surviving group showed a tendency to decrease over time, while they tended to gradually increase in the non-surviving group. sTREM-1 levels in the non-surviving group were higher than those in the surviving group at all time points, whereas CRP and PCT levels showed a tendency to decrease over time in both groups. sTREM-1 levels and Sequential Organ Failure Assessment (SOFA) scores were positively correlated (r = 0.443; P < 0.001), and this correlation coefficient was greater than the correlation coefficients for both CRP and PCT. Serum sTREM-1 levels reflected the severity of sepsis more accurately than those of CRP and PCT and were more sensitive for dynamic evaluations of sepsis prognosis. Current controlled trials ChiCTR-OCH-09000745