Expression Of Soluble Triggering Receptor Expressed On Myeloid Cells-1in Septic Patients And Its Relation With Prognosis

ObjectiveSepsis has a high incidence and high mortality, early diagnosis is important to improve the efficacy and reduce mortality. Triggering receptor expressed on myeloid cells(TREM) is a newly discovered receptor family, the members of the TREM-1is expressed on neutrophils,CD14+monocyte/macrophage cell surface transmembrane glycoprotein belonging to the immunoglobulin members of the superfamily, the soluble form of TREM-1is closely related with sepsis. In this study, by the detection of the Serum of sTREM-1concentration for the sepsis patients, analyze the trends, explore of sTREM-1relationship with sepsis severity of disease and prognosis, and provide a new way of thinking to diagnosis and prognosis of sepsis.Methods1. Using prospective, control study design, a total of50sepsis patients with sepsis who admitted in ICU department of the hospital from March2009to December2009were enrolled. The patients were divided into groups according to the patient’s condition. Using30healthy subjects in the same period as control group.2. Record the Clinical and laboratory data of the sepsis patients on the1st,3rd and7th day after onset including blood routine, blood chemistry, blood gas analysis, C-reactive protein (CRP), procalcitonin, and APACHEII score.3. Using ELISA to check sTREM-1concentration in serum, compare the differences between the groups.4. Correlation analysis of the sTREM-1. white blood cell count (WBC) and CRP with APACHE Ⅱ score, using Logistic regression analysis.Results1. The patients were divided into sepsis (n=28) and severe sepsis (n=22) groups according to the patient’s condition. Then the patients were divided into survival group(n=34) and death group(n=16) according to the clinical outcomes at28days after onset of sepsis.2. The sTREM-1levels in50septic patients on the1st day were higher than those of the healthy persons (P<0.01). 3. The sTREM-1levels in sepsis group on the1st,3rd and7th day was gradually decline with time. The sTREM-1levels in the sepsis group was Increased first and reached a peak in the3rd days, then decreased gradually. The sTREM-1levels in severe sepsis group on the1st,3rd and7th day were higher than those of the sepsis group(P<0.01).4. The sTREM-1levels of the survival group on the1st,3rd and7th day were decreased with the progression of the ailment. The sTREM-1levels did not differ significantly between the control group and survival group on the7th day (P>0.05). The sTREM-1levels in the death group on the1st,3rd and7th day were increased with the progression of the ailment.5. The Level of APACHE Ⅱ score were positive correlated with sTREM-1. but no correlative with WBC and CRP.6. Logistic regression analysis showed that sTREM-1and APACHE Ⅱ score might be potential prognostic factor for septic patients. The area under the receiver operator characteristic curve was0.868and0.930. The sensitivity of prognostic evaluation was81.1%and specificity was74.5%with sTREM-150pg/ml. and the sensitivity was83.8%and specificity was86.3%with APACHE Ⅱ score20to estimate the outcome.Conclusion1. sTREM-1levels increased significantly at the early stage in Sepsis, and may provide the basis for the early stage of sepsis diagnosis.2. Sepsis patients with the onset of extension, The sTREM-1levels in sepsis group was gradually declined. And The sTREM-1levels in the sepsis group was Increased first and reached a peak in the3rd days, then decreased gradually. The sTREM-1levels in the the survival group was gradually declined and was gradually increased. In the death group.3. The sTREM-1is significantly correlated with APACHE Ⅱ score. It is a prognostic factors of the risk of death.