可溶性 TREM-1、降钙素原和 C 反应蛋白血清水平作为重症监护病房新发发热脓毒症患者菌血症检测标志物的价值：一项前瞻性队列研究。
Value of soluble TREM-1, procalcitonin, and C-reactive protein serum levels as biomarkers for detecting bacteremia among sepsis patients with new fever in intensive care units: a prospective cohort study.
机构信息
Department of Respiratory Medicine, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan Province 572013, China.
出版信息
BMC Infect Dis. 2012 Jul 18;12:157. doi: 10.1186/1471-2334-12-157.
BACKGROUND
The purpose of this study was to explore the diagnostic value of soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for differentiating sepsis from SIRS, identifying new fever caused by bacteremia, and assessing prognosis when new fever occurred.
METHODS
We enrolled 144 intensive care unit (ICU) patients: 60 with systemic inflammatory response syndrome (SIRS) and 84 with sepsis complicated by new fever at more than 48 h after ICU admission. Serum sTREM-1, PCT, and CRP levels were measured on the day of admission and at the occurrence of new fever (>38.3°C) during hospitalization. Based on the blood culture results, the patients were divided into a blood culture-positive bacteremia group (33 patients) and blood culture-negative group (51 patients). Based on 28-day survival, all patients, both blood culture-positive and -negative, were further divided into survivor and nonsurvivor groups.
RESULTS
On ICU day 1, the sepsis group had higher serum sTREM-1, PCT, and CRP levels compared with the SIRS group (P <0.05). The areas under the curve (AUC) for these indicators were 0.868 (95% CI, 0.798-0.938), 0.729 (95% CI, 0.637-0.821), and 0.679 (95% CI, 0.578-0.771), respectively. With 108.9 pg/ml as the cut-off point for serum sTREM-1, sensitivity was 0.83 and specificity was 0.81. There was no statistically significant difference in serum sTREM-1 or PCT levels between the blood culture-positive and -negative bacteremia groups with ICU-acquired new fever. However, the nonsurvivors in the blood culture-positive bacteremia group had higher levels of serum sTREM-1 and PCT (P <0.05), with a prognostic AUC for serum sTREM-1 of 0.868 (95% CI, 0.740-0.997).
CONCLUSIONS
Serum sTREM-1, PCT, and CRP levels each have a role in the early diagnosis of sepsis. Serum sTREM-1, with the highest sensitivity and specificity of all indicators studied, is especially notable. sTREM-1, PCT, and CRP levels are of no use in determining new fever caused by bacteremia in ICU patients, but sTREM-1 levels reflect the prognosis of bacteremia.
TRIAL REGISTRATION
ClinicalTrial.gov identifier NCT01410578.
背景
本研究旨在探讨可溶性髓系细胞触发受体 1（sTREM-1）、降钙素原（PCT）和 C 反应蛋白（CRP）血清水平在鉴别脓毒症与全身炎症反应综合征（SIRS）、鉴别 ICU 获得性新发热性菌血症以及评估新发热发生时预后方面的诊断价值。
方法
共纳入 144 例 ICU 患者：60 例全身炎症反应综合征（SIRS）患者和 84 例脓毒症合并 ICU 入住后 48 小时以上新发热患者。于入院当天及第 1 次新发热时（体温＞38.3°C）检测血清 sTREM-1、PCT 和 CRP 水平。根据血培养结果，将患者分为血培养阳性菌血症组（33 例）和血培养阴性组（51 例）。根据 28 天生存情况，所有患者（血培养阳性和阴性）进一步分为存活组和死亡组。
结果
入住 ICU 第 1 天，脓毒症组血清 sTREM-1、PCT 和 CRP 水平高于 SIRS 组（P＜0.05）。各指标曲线下面积（AUC）分别为 0.868（95%CI：0.798-0.938）、0.729（95%CI：0.637-0.821）和 0.679（95%CI：0.578-0.771）。以血清 sTREM-1 为 108.9pg/ml 为截断点时，其灵敏度为 0.83，特异度为 0.81。与 ICU 获得性新发热性菌血症相比，血培养阳性和阴性菌血症组患者血清 sTREM-1 或 PCT 水平无统计学差异。然而，血培养阳性菌血症组的死亡患者血清 sTREM-1 和 PCT 水平更高（P＜0.05），血清 sTREM-1 预测预后的 AUC 为 0.868（95%CI：0.740-0.997）。
结论
血清 sTREM-1、PCT 和 CRP 水平在脓毒症早期诊断中均具有一定作用，其中以所有研究指标中灵敏度和特异度最高的血清 sTREM-1 最为显著。血清 sTREM-1、PCT 和 CRP 水平对 ICU 患者菌血症引起的新发热无鉴别作用，但 sTREM-1 水平反映了菌血症的预后。
试验注册
ClinicalTrials.gov 标识符 NCT01410578。
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