Combined measurement of procalcitonin and soluble TREM-1 in the diagnosis of nosocomial sepsis.
This prospective, non-interventional study was conducted in a medical adult intensive care unit to determine the usefulness of procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determinations in the diagnosis of nosocomial sepsis. Serum PCT and bronchoalveolar lavage fluid sTREM-1 concentrations were measured in 50 critically ill patients suffering from nosocomial sepsis. Ventilator-associated pneumonia (VAP) was diagnosed in 31 patients and extrapulmonary sepsis in 19. Increase serum PCT concentration (>0.15 ng/ml) was found in 44 (88%) patients and was higher in those suffering from a non-pulmonary sepsis. The concomitant BAL sTREM-1 determination correctly classified pulmonary (VAP) versus non-pulmonary origin in 41 out of 44 cases (93%). Even when PCT concentration remained low, sTREM-1 assessment allowed for the detection of the sepsis (VAP) in 50% of cases. Both PCT and sTREM-1 concentrations were low in only 3 patients (6%) in whom sepsis could have been missed if only diagnosed by the measurement of these 2 biomarkers. We therefore concluded that the combined measurement of serum PCT and BAL sTREM-1 concentrations could be of interest in detecting the presence of a nosocomial sepsis and in discriminating VAP versus extrapulmonary infection.
Gibot
Sebastien
S
Service de Réanimation Médicale, Hôpital Central, Nancy, France. s.gibot@chu-nancy.fr
Cravoisy
Aurelie
A
Dupays
Rachel
R
Barraud
Damien
D
Nace
Lionel
L
Levy
Bruno
B
Bollaert
Pierre-Edouard
PE
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003428:Cross Infection / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008562:Membrane Glycoproteins / Q000378:metabolism*; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D011971:Receptors, Immunologic / Q000378:metabolism*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D015415:Biomarkers; C000606589:CALCA protein, human; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide