Role Of Soluble Myeloid Cell Trigger Receptor-1 In Children With Acute Infectious Diarrhea

Objective: The aims of this paper focused on analyzing the expression levels of soluble triggering receptor-1 on myeloid cells(sTREM-1)in the plasma of children with AID and comparing the expression levels of sTREM-1 in bacterial and viral infectious diarrhea before and after treatment,so as to explore the sensitivity and specificity of sTREM-1 in early identification of pathogen type and prognosis in children with AID,and to provide a new and feasible early and rapid detection index and potential treatment target for AID in children.Methods: The experimental group consisted of 60 children with AID who were hospitalized in the Department of Pediatrics of xxx Hospital from October 2020 to September 2022,including bacterial infectious diarrhea group(n=30)and viral infectious diarrhea group(n=30).Thirty children who attended our pediatric health department during the same period for health checkups were enrolled as the control group.3ml of Venous blood was drawn on the clinical day of treatment in the control group and on the day of admission and 5 days after admission in the experimental group.All specimens were measured for sTREM-1 levels by ELISA,with a comparison of the levels of sTREM-1 in plasma between the three groups.We also compared the efficiency of sTREM-1 and CRP in the diagnosis and differentiation of AID.The independent risk factors of AID in children were investigated by multi-factor logistic stepwise regression analysis.The clinical data and laboratory indices of the experiment group were collected and conducted statistical analysis.Results:1.The general situations: the age,gender information and clinical symptoms such as vomiting and dehydration were not significantly different among the three groups of children.In the bacterial group,the number of days of admission was longer than that of the viral group,and the admission temperature was higher than that of the viral group,with statistically significant differences(P<0.001).The presence and number of white blood cells,red blood cells and mucus in the stool of the bacterial group were higher compared to the viral group,and the differences was statistically significant(P<0.001).2.sTREM-1 was expressed in both AID and healthy children.The mean expression level of sTREM-1 in the plasma of children in the three groups before treatment was compared: bacterial group > viral group > control group,and all differences among the groups had statistical significance(P<0.05).The mean expression level of sTREM-1 was considerably higher in children with severe bacterial diarrhea compared with those with milder forms(P<0.05),whereas in the viral group the expression levels were not considerably different between children with milder and heavier forms(P>0.05).3.The levels of WBC,PCT and CRP in the bacteria group before treatment were significantly higher than those in the viral diarrhea group and the control group(P<0.001),whereas the comparison between the viral and control groups was not substantially different(P>0.05);and the expression levels of PCT and CRP in the severe children were higher in children with heavy diarrhea than in children with lighter diarrhea in the bacterial group,and the differences were observed statistically(P<0.05).In contrast,the expression levels of all three were not remarkably distinct between children in the mild and severe viral groups(P>0.05).4.The mean expression levels of plasma sTREM-1,CRP and WBC in both the bacteria group and virus group were significantly decreased after treatment compared with the pre-treatment levels,and the differences were scientifically meaningful(P<0.001).5.The pre-treatment plasma sTREM-1 levels in the bacterial group were significantly positively correlated with CRP expression levels(r=0.72,P<0.05),whereas in the viral group they were no significantly correlated(r = 0.16,P>0.05).6.There was a significant positive correlation between plasma sTREM-1 expression levels and PCT in the bacterial group before treatment(r=0.46,P<0.05),while there was no significant correlation in the viral group(r=0.21,P>0.05).7.The predictive value of plasma sTREM-1,CRP,and PCT for AID was evaluated using ROC curves.The results demonstrated that with a cut-off value of 229.84 pg/ml for sTREM-1,the AUC value,sensitivity,and specificity for the diagnosis and prediction of AID were 0.87,83.33%,and 83.33%,and for CRP with a cut-off value of 5.6 ng/ml,the AUC value,sensitivity,and specificity were 0.77,65%,and 83.33%,and when the PCT was taken as the best cut-off value,the AUC value,sensitivity and specificity were 0.83,71.67% and83.33%,respectively.sTREM-1,PCT and CRP all had certain predictive value for the diagnosis of AID,among which sTREM-1 had more predictive advantages than PCT and CRP.8.We assessed the discrimination efficacy of sTREM-1,PCT and CRP for bacterial diarrhea and viral diarrhea using ROC curves,and the results showed that sTREM-1 had an AUC value of 0.91,a sensitivity of 76.67% and a specificity of 96.67% when the cut-off value was 264.13 pg/ml,whereas PCT had an AUC value(0.94)and a specificity(96.70%)comparable to sTREM-1 when the cut-off value was 0.55 ng/ml,while the sensitivity(80.0%)was slightly higher than that of sTREM-1.The sensitivity(96.67%)of CRP was higher than that of sTREM-1 when the cut-off value was 6.33 ng/ml,while the specificity(73.33%)and AUC value(0.86)were much lower than that of sTREM-1 and PCT.It is confirmed that sTREM-1 and PCT are more effective in identifying viral diarrhea and bacterial diarrhea in comparison with CRP.Conclusion:1.sTREM-1 is involved in the pathogenesis of AID,and its expression level is higher,suggesting a greater possibility of bacterial diarrhea.2.sTREM-1 is a sensitive indicator for diagnosis of AID,identification of the pathogen and indication of the severity of the disease.