title: sTREM-1 and LBP in central venous catheter-associated bloodstream infections in pediatric intestinal failure.
abstract: OBJECTIVE
  Central venous catheter-associated bloodstream infections (CVC-BSIs) are a major cause of morbidity and mortality in the pediatric intestinal failure (IF) population. We assessed plasma lipopolysaccharide-binding protein (LBP) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as biomarkers for CVC-BSI. We hypothesized that sTREM-1 and LBP rise with BSI and decline following treatment, and that baseline LBP is higher in the IF population than in controls.
  
  
  METHODS
  Patients younger than 4 years were recruited from the IF registry at Cincinnati Children's Hospital. LBP and sTREM-1 levels were measured on 22 patients with IF at baseline, 17 patients with IF with BSIs, and 11 healthy controls.
  
  
  RESULTS
  Mean sTREM-1 level (pg/mL) and LBP level (μg/mL) rose with CVC-BSI over baseline (115.0 ± 51.2 vs 85.9 ± 27.6, P = 0.011 and 79.8 ± 45.4 vs 20.5 ± 11.3, P < 0.001, respectively) and declined following antibiotic therapy (115.0 ± 51.2 vs 77.9 ± 29.8, P = 0.003 and 79.8 ± 45.4 vs 26.2 ± 10.8, P < 0.001, respectively). Receiver operating characteristic curves showed that neither sTREM-1 nor LBP is sufficient to predict bacteremia versus fever without bacteremia (area under these curves = 0.57 and 0.82, respectively). Baseline LBP was higher in hospitalized patients than in outpatients (27.5 ± 8.7 vs 13.5 ± 9.2, P = 0.002), patients with previous BSIs versus those without (23.5 ± 10.4 vs 10.1 ± 8.3, P = 0.016), and those listed for transplantation versus those not listed (29.6 ± 9.8 vs 16.2 ± 9.5, P = 0.033).
  
  
  CONCLUSIONS
  sTREM-1 and LBP rise with CVC-BSI in IF and decline after treatment; however, neither distinguishes infection from nonbacteremic febrile episodes. Baseline LBP may be a marker of disease severity in IF.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. ekevan@ghs.org
authors.forename: Emily N
authors.initials: EN
authors.lastname: Kevan
authors.forename: Julia R
authors.initials: JR
authors.lastname: Simmons
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kocoshis
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Cohen
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rudolph
mesh_terms: D000209:Acute-Phase Proteins; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002352:Carrier Proteins / Q000097:blood*; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002675:Child, Preschool; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines / Q000382:microbiology / Q000503:physiopathology*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D011971:Receptors, Immunologic / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D000099231:Lipopolysaccharide-Binding Protein; C408842:TREM1 protein, human