Zhou Jian, Zhou Jingqian, Hong Yan, Wang Youcheng, Lin Hailong, Huang Leting
Department of Pediatrics, The First People's Hospital of Yongkang, Jinhua, China.
Department of Pediatrics, The Central Hospital of Wuhan, Wuhan, China.
Front Pediatr. 2021 Aug 25;9:664801. doi: 10.3389/fped.2021.664801. eCollection 2021.
Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is regarded as a biological marker of infection. We aimed to evaluate the diagnostic value of endotracheal tube (ETT)-sTREM-1 concentration in neonatal ventilator-associated pneumonia (NVAP), to explore the difference of (ETT)-sTREM-1 between preterm and full-term, and to investigate the influence of extrapulmonary infection on (ETT)-sTREM-1 concentration. In this multicenter, controlled clinical trial of 60 preterm and 33 full-term neonates on mechanical ventilators, we measured concentrations of ETT-aspirate and serum sTREM-1, serum C-reactive protein, and serum procalcitonin, as well as white blood cell count. We initially divided cases into eight groups, based on three categories: preterm of full-term; NVAP or non-NVAP; and extrapulmonary infection present or absent. Groups were compared, and logistic regression analysis and receiver operating characteristic (ROC) analysis was performed to determine diagnostic value. The mean gestational age (± standard deviation) of preterm and full-term neonates was 28.9 ± 2.2 weeks and 39.5 ± 1.7 weeks, respectively, and 32/60 were male. The ETT-aspirate sTREM-1 concentration was higher in NVAP cases than in non-NVAP cases, irrespective of extrapulmonary infection. ROC analysis revealed that ETT-aspirate sTREM-1 concentration had an area under the curve (AUC) of 0.986 and a cutoff value of 228.0 pg/ml (sensitivity, 94.3%; specificity, 96%) in preterm neonates; the same values in full-term neonates were 0.938 and 245.5 pg/ml (sensitivity, 100%; specificity, 93.7%), respectively. The optimal combination of indicators was ETT-aspirate sTREM-1 and serum C-reactive protein concentration. All indicators were present at lower levels on days 8 and 10 of ventilation in neonates who ultimately recovered than in those who did not. ETT-aspirate sTREM-1 and serum C-reactive protein concentrations may be useful for the diagnosis of NVAP.
髓系细胞触发受体-1（sTREM-1）被视为感染的生物学标志物。我们旨在评估气管内插管（ETT）-sTREM-1浓度在新生儿呼吸机相关性肺炎（NVAP）中的诊断价值，探讨早产儿和足月儿ETT-sTREM-1的差异，并研究肺外感染对ETT-sTREM-1浓度的影响。在这项多中心对照临床试验中，对60例使用呼吸机的早产儿和33例足月儿进行研究，我们检测了ETT吸取物和血清sTREM-1、血清C反应蛋白、血清降钙素原的浓度，以及白细胞计数。我们最初根据三个类别将病例分为八组：早产或足月；NVAP或非NVAP；以及有无肺外感染。对各组进行比较，并进行逻辑回归分析和受试者工作特征（ROC）分析以确定诊断价值。早产儿和足月儿的平均胎龄（±标准差）分别为28.9±2.2周和39.5±1.7周，60例中有32例为男性。无论有无肺外感染，NVAP病例的ETT吸取物sTREM-1浓度均高于非NVAP病例。ROC分析显示，早产儿ETT吸取物sTREM-1浓度的曲线下面积（AUC）为0.986，截断值为228.0 pg/ml（敏感性为94.3%；特异性为96%）；足月儿的相应值分别为0.938和245.5 pg/ml（敏感性为100%；特异性为93.7%）。最佳指标组合为ETT吸取物sTREM-1和血清C反应蛋白浓度。最终康复的新生儿在通气第8天和第10天所有指标的水平均低于未康复的新生儿。ETT吸取物sTREM-1和血清C反应蛋白浓度可能有助于NVAP的诊断。
