Effect of sTREM-1 on prognosis of patients with ventilator-associated pneumonia / 中华急诊医学杂志

ABSTRACT

Objective To explore the prognostic value of soluble triggering receptor expressed on myeloid cells-1(sTREM-1) in patients with ventilator-associated pneumonia (VAP).Methods A total of 103 VAP patients were enrolled from June 2013 to May 2015 in the ICU of Wuxi People's Hospital Affiliated to Nanjing Medical University.The demographics and clinical data were collected,while serum sTREM-1,procalcitonin (PCT),C-reactive protein(CRP),clinical pulmonary infection score(CPIS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) were measured.Patients were divided into the death group and the survival group according to 28 d survival.The differences in demographics and clinical data were compared between groups.The values of sTREM-1,PCT,CPIS and APACHE Ⅱ for predicting 28 d death were evaluated by receiver operating curves(ROC).The surviving curve was drawn by Kaplan-Meier method.The possible prognostic factors were analyzed by univadate and logistic multivariate analysis.Results There were 76 patients in the survival group and 27 patients in the death group,and there was no difference in demographics between two groups(P＞0.05).The serum sTREM-1,PCT,CPIS and APACHE Ⅱ were higher in the death group[(89.50±18.45) pg/mL,(823.86±182.74) pg/ mL,(7.20±1.74) and (19.58±3.43)] than those in the survival group[(54.09±12.71) pg/mL,(579.81±193.45) pg/mL,(4.79±1.93) and (17.23±3.12),all P＜0.05].The areas under the ROC of sTREM-1,PCT,CPIS and APACHE Ⅱ for predicting 28 d death were 0.84±0.04(95％CI0.75-0.92,P＜0.01),0.65±0.05(95％CI0.55-0.74,P=0.49),0.67±0.06(95％CI0.55-0.79,P＜0.01),0.79±0.04(95％CI0.70-0.87,P=0.03),respectively.Patients were assigned into two groups by the best cutoffpoint of sTREM-l=75.00 pg/mL,and Kaplan-Meier survival analysis showed that 28 d survival rate in the low sTREM-1 group was significantly higher than that in the high sTREM-1 group (82.5％ vs.63.4％,x2=3.96,P＜0.05).Multivariate logistic regression analysis showed that both sTREM-1 (OR=1.08,95％CI1.04-1.13,P＜0.01) andAPACHE Ⅱ (OR=1.39,95％CI1.15-1.67,P＜0.01) were risk factors associated with 28 d death.Conclusions Early serum sTREM-1 can be used as a reliable predictor for the outcome of patients with VAP.