Soluble triggering receptor expressed on myeloid cells in severe acute pancreatitis: a biological marker of infected necrosis.
OBJECTIVE
The diagnosis and treatment of secondary infection of pancreatic necrotic tissue remain a major challenge. The level of soluble triggering receptor expressed on myeloid cells (sTREM-1) in fine needle aspiration (FNA) fluid may be a good marker of infected necrosis.


METHODS
Patients with a clinical suspicion of secondary infection of necrotic tissue were enrolled. The serum levels of C-reactive protein, amylase, procalcitonin (PCT), and sTREM-1 and the fluid levels of sTREM-1, PCT, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and amylase were examined. When infected necrosis was defined, the first step was percutaneous or endoscopic drainage. If there was no improvement after 72 h, an open necrosectomy was performed.


RESULTS
In 30 patients with suspected infection, 18 patients were diagnosed as having secondary infection of necrotic tissue. The levels of sTREM-1 and PCT in FNA fluid were found to have the closest correlation with the diagnosis of infected necrosis [sTREM-1: area under the receiver operating characteristic curve (AUC) 0.972; 95% confidence interval (95%CI) 0.837-1.000; PCT: AUC 0.903; 95%CI 0.670-0.990, P > 0.05]. A fluid sTREM-1 cutoff value of 285.6 pg/ml had a sensitivity of 94.4% and a specificity of 91.7%. In a multiple logistic regression analysis, an sTREM-1 level of more than 285 pg/ml and a PCT level of more than 2.0 ng/ml in FNA fluid were independent predictors of infected necrosis.


CONCLUSIONS
The fluid level of sTREM-1 will help in the rapid and accurate diagnosis of secondary infection of necrotic tissue in patients with severe acute pancreatitis (SAP).
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zheng
Z
Lu
Yan
Y
Liu
Yuan-hang
YH
Dong
Xian-bao
XB
Zhan
Yi-qi
YQ
Du
Jun
J
Gao
Yan-fang
YF
Gong
Zhao-shen
ZS
Li
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D044963:Biopsy, Fine-Needle; D001826:Body Fluids / Q000382:microbiology*; D060085:Coinfection / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis* / Q000276:immunology*; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000503:physiopathology*; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000032:analysis* / Q000276:immunology*; D012720:Severity of Illness Index; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D015415:Biomarkers; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1