Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid cells-1 in Bronchoalveolar Lavage Fluid for Early Pulmonary Infection in Patients with Post-traumatic ARDS_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LiJianqiu ¹ , XiongXuming ² , ChenWang ³ , XuZhikang ³ , LaiJianbo ¹ , ChenHouwang ¹

1. Department of Critical Care Medicine, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, Guangdong, 518104, China;
2. ;
3. ;

Corresponding author：

LiJianqiu, Email: pumaball@21cn.com

Keywords：

Trauma; Acute respiratory distress syndrome; Pulmonary infection; Bronchoalveolar lavage fluid; Soluble triggering receptor expressed on myeloid cells-1

DOI：

10.7507/1671-6205.2014058

Video：

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Objective To evaluate the diagnostic value of sTREM-1 level in bronchoalveolar lavage fluid (BALF) for diagnosing early lung infection of patients with post-traumatic acute respiratory distress syndrome. Methods 64 patients with post-traumatic ARDS,who were admitted in ICU from emergency department or other trauma surgery department from January 2010 to December 2012,were divided into a pulmonary infection group (n=34) and a non-pulmonary infection group(n=30).30 healthy volunteers aged over 18 years were taken as healthy control group.The ROC curve was used to analyze the diagnostic value of C-reactive protein (CRP),procalcitonin (PCT) and sTREM-1 in early pulmonary infection of patients with post-traumatic ARDS. Results Gender and age composition showed no significant difference among the healthy control group,the pulmonary infection group,and the non-pulmonary infection group(P>0.05). Injury severity scale(ISS),APACHEⅡ and the mortality in 28 days showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.05).Oxygenation index (PaO₂/FiO₂),tracheal intubation time,mechanical ventilation time and length of ICU stay also showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.01).Compared with the healthy control group,levels of serum CRP,PCT and sTREM-1 increased significantly in the groups of pulmonary infection and non-pulmonary infection(P<0.001).Compared with the non-pulmonary infection group,the levels of CRP,PCT and sTREM-1 in serum,and sTREM-1 in BALF increased significantly in the pulmonary infection group (P<0.05).The area under the ROC curve (AUC) of serum CRP was 0.67 with the sensitivity of 0.68 and the specificity of 0.70.AUC of serum PCT was 0.67 with the sensitivity of 0.70 and the specificity of 0.64.AUC of serum sTREM-1 was 0.73 with the sensitivity of 0.73 and the specificity of 0.68.AUC of sTREM-1 in BALF was 0.90 with the sensitivity of 0.90 and the specificity of 0.82. Conclusion sTREM-1 in BALF can be used as a diagnostic indicator for early pulmonary infection in patients with post-traumatic ARDS.Its sensitivity and specificity are higher than serum CRP,PCT and sTREM-1.

Citation： LiJianqiu, XiongXuming, ChenWang, XuZhikang, LaiJianbo, ChenHouwang. Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid cells-1 in Bronchoalveolar Lavage Fluid for Early Pulmonary Infection in Patients with Post-traumatic ARDS. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 241-245. doi: 10.7507/1671-6205.2014058 Copy

1.	陆月明,顾秀莲.急性呼吸窘迫综合征研究进展.中华流行病学杂志,2005,26:463-465.
2.	García-González MJ,Domínguez-Rodríguez A,Ferrer-Hita JJ.Unusual etiology of acute lung injury in a patient with acute myocardial infarction.Int J Cardiol,2007,117:e95-e97.
3.	Lazarus HM,Fox J,Lloyd JF,et al.A six-year descriptive study of hospital-associated infection in trauma patients:demographics,injury features,and infection patterns.Surg Infect (Larchmt),2007,8:463-473.
4.	吴友平,李金宝,邓小明.可溶性髓细胞触发受体1对呼吸机相关性肺炎诊断价值的系统评价.中国呼吸与危重监护杂志,2013,12:258-263.
5.	The ARDS Definition Task Force.Acute respiratory distress syndrome,the Berlin definition.JAMA,2012,307:E1-E8.
6.	中华人民共和国卫生部.医院感染诊断标准.中华医学杂志,2001,81:314-320.
7.	Lausevic Z,Lausevic M,Trbojevic-Stankovic J,et al.Predicting multiple organ failure in patients with severe trauma.Can J Surg,2008,51:97-102.
8.	Wallace WC,Cinat M,Gornick WB,et al.Nosocomial infections in the surgical intensive care unit:a difference between trauma and surgical patients.Am J Surg,1999,65:987-990.
9.	Silvestre J,Coelho L,Póvoa P.Should C-reactive protein concentration at ICU discharge be used as a prognostic marker.BMC J Anesthesiol,2010,10:17-22.
10.	Castelli GP,Pognani C,Cita M,et al.Procalcitonin,C-reactive protein,white blood cells and SOFA score in ICU:diognosis and monitoring of sepsis.Minerva Anesthesiol,2006,72:69-80.
11.	Silvestre J,Póvoa P,Coelho L,et al.Is C-reactive protein a good prognostic marker in septic patients.Intensive Care Med,2009,35:909-913.
12.	Uzzan B,Cohen R,Nicolas P,et al.Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma:a systematic review and meta-analysis.Crit Care Med,2006,34:1996-2003.
13.	Hochreiter M,Köhler T,Schweiger AM,et al.Procalcitonin to guide duration of antibiotic therapy in intensive care patients:a randomized prospective controlled trial.Crit Care,2009,13:R83.
14.	Ruiz-Alvarez MJ,García-Valdecasas S,De Pablo R,et al.Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.J Intensive Care Med,2009,24:63-71.
15.	Preas HL,Nylen ES,Snider RH,et al.Effects of anti-inflammatory agents on serum levels of calcitonin precursors during human experimental endotoxemia.Infect Dis,2001,184:373-376.
16.	Casado-Flores J,Blanco-Quiros A.Procalcitonin:a new marker for bacterial infection.An Esp Pediatr,2001,54:69-73.
17.	Tang BM,Eslick GD,Craig JC,et al.Accuracy of procalcitonin for sepsis diagnosis in critically ill patients:systematic review and metaanalysis.Lancet Infect Dis,2007,7:210-217.
18.	Gibot S,Cravoisy A,Kolopp-Sarda MN,et al.Time-course of sTREM (soluble triggering receptor expressed on myeloid cells)-1,procalcitonin,and C-reactive protein plasma concentrations during sepsis.Crit Care Med,2005,33:792-796.
19.	Rivera-Chavez FA,Minei JP.Soluble triggering receptor expressed on myeloid cells-1 is an early marker of infection in the surgical intensive care unit.Surg Infect (Larchmt),2009,10:435-439.
20.	Bingold TM,Pullmann B,Sartorius S,et al.Soluble triggering receptor on myeloid cells-1 is expressed in the course of non-infectious inflammation after traumatic lung contusion:a prospective cohort study.Crit Care,2011,15:R115.
21.	Kofoed K,Andersen O,Kronborg G,et al.Use of plasma C-reactive protein,procalcitonin,neutrophils,macrophage migration inhibitory factor,soluble urokinase-type plasminogen activator receptor,and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections:a prospective study.Crit Care,2007,11:R38.
22.	Lin MT,Wei YF,Ku SC,et al.Serum soluble triggering receptor expressed on myeloid cells-1 in acute respiratory distress syndrome:a prospective observational cohort study. J Formos Med Assoc,2010,109:800-809.
23.	Siranovi Ac'G M,Kovac J,Gopcevi Ac'G S,et al.Human soluble TREM-1:lung and serum levels in patients with bacterial ventilator associated pneumonia. Acta Clin Croat,2011,50:345-349.
24.	Gibot S,Cravoisy A,Levy B,et al.Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia.N Engl J Med,2004:451-458.
25.	Huh JW,Lim CM,Koh Y,et al.Diagnostic utility of the soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid from patients with bilateral lung infiltrates. Crit Care,2008,12:R6.

1. 陆月明,顾秀莲.急性呼吸窘迫综合征研究进展.中华流行病学杂志,2005,26:463-465.
2. García-González MJ,Domínguez-Rodríguez A,Ferrer-Hita JJ.Unusual etiology of acute lung injury in a patient with acute myocardial infarction.Int J Cardiol,2007,117:e95-e97.
3. Lazarus HM,Fox J,Lloyd JF,et al.A six-year descriptive study of hospital-associated infection in trauma patients:demographics,injury features,and infection patterns.Surg Infect (Larchmt),2007,8:463-473.
4. 吴友平,李金宝,邓小明.可溶性髓细胞触发受体1对呼吸机相关性肺炎诊断价值的系统评价.中国呼吸与危重监护杂志,2013,12:258-263.
5. The ARDS Definition Task Force.Acute respiratory distress syndrome,the Berlin definition.JAMA,2012,307:E1-E8.
6. 中华人民共和国卫生部.医院感染诊断标准.中华医学杂志,2001,81:314-320.
7. Lausevic Z,Lausevic M,Trbojevic-Stankovic J,et al.Predicting multiple organ failure in patients with severe trauma.Can J Surg,2008,51:97-102.
8. Wallace WC,Cinat M,Gornick WB,et al.Nosocomial infections in the surgical intensive care unit:a difference between trauma and surgical patients.Am J Surg,1999,65:987-990.
9. Silvestre J,Coelho L,Póvoa P.Should C-reactive protein concentration at ICU discharge be used as a prognostic marker.BMC J Anesthesiol,2010,10:17-22.
10. Castelli GP,Pognani C,Cita M,et al.Procalcitonin,C-reactive protein,white blood cells and SOFA score in ICU:diognosis and monitoring of sepsis.Minerva Anesthesiol,2006,72:69-80.
11. Silvestre J,Póvoa P,Coelho L,et al.Is C-reactive protein a good prognostic marker in septic patients.Intensive Care Med,2009,35:909-913.
12. Uzzan B,Cohen R,Nicolas P,et al.Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma:a systematic review and meta-analysis.Crit Care Med,2006,34:1996-2003.
13. Hochreiter M,Köhler T,Schweiger AM,et al.Procalcitonin to guide duration of antibiotic therapy in intensive care patients:a randomized prospective controlled trial.Crit Care,2009,13:R83.
14. Ruiz-Alvarez MJ,García-Valdecasas S,De Pablo R,et al.Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.J Intensive Care Med,2009,24:63-71.
15. Preas HL,Nylen ES,Snider RH,et al.Effects of anti-inflammatory agents on serum levels of calcitonin precursors during human experimental endotoxemia.Infect Dis,2001,184:373-376.
16. Casado-Flores J,Blanco-Quiros A.Procalcitonin:a new marker for bacterial infection.An Esp Pediatr,2001,54:69-73.
17. Tang BM,Eslick GD,Craig JC,et al.Accuracy of procalcitonin for sepsis diagnosis in critically ill patients:systematic review and metaanalysis.Lancet Infect Dis,2007,7:210-217.
18. Gibot S,Cravoisy A,Kolopp-Sarda MN,et al.Time-course of sTREM (soluble triggering receptor expressed on myeloid cells)-1,procalcitonin,and C-reactive protein plasma concentrations during sepsis.Crit Care Med,2005,33:792-796.
19. Rivera-Chavez FA,Minei JP.Soluble triggering receptor expressed on myeloid cells-1 is an early marker of infection in the surgical intensive care unit.Surg Infect (Larchmt),2009,10:435-439.
20. Bingold TM,Pullmann B,Sartorius S,et al.Soluble triggering receptor on myeloid cells-1 is expressed in the course of non-infectious inflammation after traumatic lung contusion:a prospective cohort study.Crit Care,2011,15:R115.
21. Kofoed K,Andersen O,Kronborg G,et al.Use of plasma C-reactive protein,procalcitonin,neutrophils,macrophage migration inhibitory factor,soluble urokinase-type plasminogen activator receptor,and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections:a prospective study.Crit Care,2007,11:R38.
22. Lin MT,Wei YF,Ku SC,et al.Serum soluble triggering receptor expressed on myeloid cells-1 in acute respiratory distress syndrome:a prospective observational cohort study. J Formos Med Assoc,2010,109:800-809.
23. Siranovi Ac'G M,Kovac J,Gopcevi Ac'G S,et al.Human soluble TREM-1:lung and serum levels in patients with bacterial ventilator associated pneumonia. Acta Clin Croat,2011,50:345-349.
24. Gibot S,Cravoisy A,Levy B,et al.Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia.N Engl J Med,2004:451-458.
25. Huh JW,Lim CM,Koh Y,et al.Diagnostic utility of the soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid from patients with bilateral lung infiltrates. Crit Care,2008,12:R6.

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Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid cells-1 in Bronchoalveolar Lavage Fluid for Early Pulmonary Infection in Patients with Post-traumatic ARDS

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