血清可溶性髓系细胞触发受体-1 水平升高可识别肝硬化合并细菌感染患者，并预测其 90 天死亡率。

Increased sTREM-1 levels identify cirrhotic patients with bacterial infection and predict their 90-day mortality.

机构信息

Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary; Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary.

Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary.

出版信息

Clin Res Hepatol Gastroenterol. 2021 Sep;45(5):101579. doi: 10.1016/j.clinre.2020.11.009. Epub 2021 Mar 25.

DOI:10.1016/j.clinre.2020.11.009

PMID:33773436

Abstract

BACKGROUND AND AIMS

Patients with cirrhosis are susceptible to bacterial infections (BIs) that are major causes of specific complications and mortality. However, the diagnosis of BIs can often be difficult in advanced disease stage since their symptoms may overlap with the ones of acute decompensation (AD). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is released from monocytes/macrophages and neutrophils during activation and has been reported to correlate with activity of various inflammatory processes. We investigated its diagnostic and prognostic performance in patients with cirrhosis and BI.

METHODS

Sera of 269 patients were assayed for sTREM-1 by ELISA (172 outpatients and 97 patients with AD of whom 56 had BI). We investigated capacity of sTREM-1 to identify patients with BI and conducted a 90-day follow-up observational study to assess its possible association with short-term mortality.

RESULTS

sTREM-1 levels were significantly higher in patients with more severe liver disease, BI, and acute-on-chronic liver failure than in patients without these conditions. sTREM-1 had similar accuracy to CRP identifying BI [sTREM-1: AUROC (95%CI) 0.804 (0.711-0.897), p < 0.0001; CRP: 0.791 (0.702-0.881), p < 0.0001)] among AD patients. The combination of these two molecules and the presence of ascites into a composite score significantly increased their discriminative power (AUROC: 0.878, 95%CI: 0.812-0.944, p < 0.0001). High sTREM-1 level (>660 pg/mL) was an independent predictor of 90-day mortality in patients with BI [HR: 2.941, (95%CI: 1.009-8.573), p = 0.048] in our multivariate model.

CONCLUSIONS

Use of sTREM-1 could increase the recognition of BIs in cirrhosis and help clinicians in mortality risk assessment of these patients.

摘要

背景与目的

肝硬化患者易发生细菌感染（BI），这是导致特定并发症和死亡的主要原因。然而，由于其症状可能与急性失代偿（AD）重叠，因此在疾病晚期，BI 的诊断往往较为困难。可溶性髓系细胞触发受体-1（sTREM-1）在单核细胞/巨噬细胞和中性粒细胞激活时从这些细胞中释放出来，并已被报道与各种炎症过程的活性相关。我们研究了 sTREM-1 在肝硬化合并 BI 患者中的诊断和预后性能。

方法

通过 ELISA 检测 269 例患者的血清 sTREM-1（172 例门诊患者和 97 例 AD 患者，其中 56 例有 BI）。我们研究了 sTREM-1 识别 BI 患者的能力，并进行了 90 天的随访观察研究，以评估其与短期死亡率的可能关联。

结果

sTREM-1 水平在肝功能更严重、有 BI 和慢加急性肝衰竭的患者中显著高于无这些情况的患者。sTREM-1 在识别 AD 患者中的 BI 方面与 CRP 具有相似的准确性[sTREM-1：AUROC（95%CI）0.804（0.711-0.897），p<0.0001；CRP：0.791（0.702-0.881），p<0.0001]。将这两种分子与腹水结合到一个复合评分中，显著提高了它们的区分能力（AUROC：0.878，95%CI：0.812-0.944，p<0.0001）。高 sTREM-1 水平（>660 pg/mL）是肝硬化合并 BI 患者 90 天死亡率的独立预测因素[HR：2.941（95%CI：1.009-8.573），p=0.048]。