Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study
Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study
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sTREM-1 在早期预测新生儿呼吸机相关肺炎中的意义：一项单中心、前瞻性、观察性研究
DOI：
10.1186/s12879-020-05196-z
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发表时间：
2020-07-25
影响因子：
3.7
通讯作者：
Feng, Xing
中科院分区：
文献类型：
--
作者：
Zhao, Xingxing;Xu, Lixiao;Feng, Xing
目的探讨髓系细胞可溶性触发受体-1（斯特雷姆-1）是否可作为呼吸机相关性肺炎（VAP）的早期预测因子。方法将2017年1月至2018年1月在呼吸内科住院的机械通气新生儿患者分为VAP组（n = 30）和非VAP组（n = 30）。在开始机械通气（MV）后0、24、72和120 h测定血清斯特雷姆、降钙素原（PCT）、C反应蛋白和白细胞介素-6水平。分析血液生物标志物浓度与VAP发生的相关性。通过Logistic回归分析和Hosmer-Lemeshow检验确定VAP的预测因素，并通过受试者工作特征曲线分析确定斯特雷姆-1和生物标志物组合对VAP的预测价值。结果VAP组患者MV后72、120 h血清斯特雷姆-1浓度显著高于非VAP组（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）。72小时时斯特雷姆-1的曲线下面积（AUC）为0.902，最佳截止值为165.05 pg/ml，灵敏度为90%，特异性为77%。在72 h时将PCT加入sTERM-1进一步提高了预测值，该组合的AUC为0.971（95%置信区间：0.938-1.000），灵敏度为0.96，特异性为0.88，约登指数为0.84。结论斯特雷姆-1是新生儿VAP的可靠预测因子，联合检测MV后72 h血清斯特雷姆-1和PCT水平可更准确地预测新生儿VAP的发生。
Background 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). Methods Ventilated 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. Results The 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. Conclusion sTREM-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.