title: sTREM-1 is a potential useful biomarker for exclusion of ongoing infection in patients with secondary peritonitis.
abstract: Identification of patients with ongoing abdominal infection after emergency surgery for abdominal sepsis is difficult. The purpose of this study was to evaluate whether plasma and abdominal fluid sTREM-1 levels can adequately select patients with ongoing abdominal infection. In a single center retrospective observational study, plasma and abdominal fluid samples were collected every 24 h for 4 days in patients who underwent an emergency laparotomy for severe secondary peritonitis. Patients after elective esophagus surgery served as controls. sTREM-1 levels were measured with an ELISA. Plasma sTREM-1 levels were not elevated compared to controls. Abdominal fluid sTREM-1 levels were initially high (median (246 [IQR 121-455] pg/ml), and declined 24 h after surgery (P=0.01). On day 2 and 3, patients with ongoing infection had significantly higher abdominal fluid sTREM-1 levels (319 [180-671] and 245 [173-541] pg/ml, respectively) compared to patients without infection (85 [49-306] and 121 [20-196] pg/ml, respectively). sTREM-1 levels were moderately predictive for persistent infection but had a high negative predictive value (0.86 (95% CI 0.69-0.94) below a cut-off level of 160 pg/ml. In clinical practice, abdominal fluid sTREM-1 levels may be useful for exclusion but not detection of ongoing abdominal infection after surgery for secondary peritonitis.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. r.m.determann@amc.uva.nl
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: J W Olivier
authors.initials: JW
authors.lastname: van Till
authors.forename: Oddeke
authors.initials: O
authors.lastname: van Ruler
authors.forename: Suzanne Q
authors.initials: SQ
authors.lastname: van Veen
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood* / Q000378:metabolism; D004724:Endoscopy; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D008562:Membrane Glycoproteins / Q000096:biosynthesis*; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011971:Receptors, Immunologic / Q000096:biosynthesis*; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis; D016896:Treatment Outcome; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1