The Clinical Value Of Soluble Triggering Receptor Expressed On Myeloid Cells-1on Hospital-Acquired Pneumonia

Objective:Hospital-Acquired Pneumonia (HAP) is an infectious disease with high morbidity, which threatens human health. Diagnosis of HAP is of the lack of a gold standard, the current domestic and international research shows biomarkers for diagnosis and treatment of HAP are of great help. This study investigated the value of sTREM-1in diagnosis and the relationship between some biomarkers and the severity of HAP,by detecting the levels of plasma C-reactive protein (CRP),procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cell-1(sTREM-1) in different body fluids of HAP patients, to provide theoretical basis for HAP elinical treatment.Methods:Thirty HAP patients whom were chosen based on the diagnostic standards of HAP in2006American ATS,and fifteen control subjects took part in this study:The HAP patients were separated into two groups:fifteen acquired severe HAP (seven are alive, eight have been dead), fifteen were mild or moderate HAP. Plasma, bronehoalveola lavage fluid (BALF) and exhaled breath condensate (EBC) were collected in patients and control subjects.Severe HAP group collected plasma,BALF and EBC on the first day and the seventh day.mild or moderate HAP group collected plasma,BALF and EBC on the first day and plasma.EBC on the seventh day. control group collected plasma,BALF and EBC on the first day or the second day.We detected the levels of sTREM-1in Plasma,BALF and EBC using enzyme linked immunosorbent assey (ELISA).The levels of plasma CRP and PCT in all subjects and the CPIS of HAP patients were recorded meanwhile. All data was expressed by mean±standard deviation (x±s),and was statistically analyzed by using Statistical Produet and Service Solutions17.0(spss17.0).P<0.05indieated a statistically difference, P<0.01indieated a statistically significant difference.Result:(1) The sTREM-1levels in plasma, BALF and EBC of severe HAP patients on the first day (ng/L:126.25±26.96,224.50±5.62,194.45±31.89) were much higher than those of the mild or moderate HAP patients (69.03±11.28、180.11±23.56、129.12±19.58,P<0.01) and were much higher than those of the control subjects(40.13±17.19、144.86±34.36、99.09±14.10,p<0.01).The sTREM-1levels in plasma, BALF and EBC of mild or moderate HAP patients on the first day were also much higher than those of the control subjects(p<0.01).(2) The levels of sTREM-1in plasma and EBC of mild or moderate HAP patients after treatment showed a trend to decrease:the sTREM-1levels in plasma and EBC on the seventh day (ng/L:46.20±5.15,57.33±10.05) much lower than those on the first day (69.03±11.28,129.12±19.58,P<0.01).(3) The levels of sTREM-1in plasma, BALF and EBC of survival subgroup of severe HAP patients after treatment showed a trend to decrease:the sTREM-1levels in plasma,BALF and EBC on the seventh day (ng/L:72.15±2.47,184.71±17.94,125.87±20.58) much lower than those on the first day (126.51±26.97,224.21±5.76,192.91±32.53,P<0.01).The levels of sTREM-1in plasma,BALF and EBC of death subgroup of severe HAP patients showed a trend to increase:the sTREM-1levels in plasma and EBC on the seventh day (ng/L:174.37±39.73,266.86±27.02) much higher than those on the first day (125.97±29.09,224.83±5.92,P<0.01).The sTREM-1levels of EBC had a rising trend, but the difference was not statistically significant.(4) For ROC curve, when the cut-off value of sTREM-1in BALF was set at152.14ng/L, the area under the ROC curve was0.864,diagnostic sensitivity of HAP was70.7%, specificity was76.4%, greater than the other markers (plasma CRP,PCT, sTREM-1and EBC sTREM-1) of this study.(5) The level of sTREM-1in plasma was correlated positively to the CPIS(r=0.718,P<0.01).The level of CRP in plasma was correlated positively to the CPIS(r=0.689,P<0.01),the other biomarkers (plasma PCT, BALF sTREM-1and EBC sTREM-1) and CPIS had a correlated trend but not obvious.Conclusion:sTREM-1increased significantly in the HAP group, suggesting that they may be assoeiated with the inflammatory process in HAP. The levels of sTREM-1in plasma, BALF and EBC has a good reference value for the diagnosis of HAP.The level of sTREM-1in BALF had greater diagnostic value of HAP.The levels of sTREM-1in plasma and BALF are relative to the severity of pneumonia. Dynamic monitoring of levels of sTREM-1and CRP in plasma,is helpful to evaluating the therapeutic effect and estimating prognosis.