title: Can sTREM-1 predict septic shock & death in late-onset neonatal sepsis? A pilot study.
abstract: OBJECTIVE
  The transmembrane glycoprotein TREM-1 triggers an inflammatory response. Its soluble fraction (sTREM-1) has been shown to have diagnostic accuracy for late-onset neonatal sepsis (LONS). Until now, the potential of sTREM-1 to predict septic shock and/or death in septic neonates has not been explored. This study obtained estimates of the incidence and prevalence of septic shock and/or death in septic neonates for future sample size calculations for confirmatory studies and evaluated the feasibility of using sTREM-1 as a predictor of septic shock and/or death in neonates with LONS criteria.
  
  
  METHODS
  A pilot study with a cross-sectional design was performed from May 1(st) to October 31(st), 2012. The participants were hospitalized neonates who, after three days of life, were diagnosed as having LONS. Plasma sTREM-1 was quantified by ELISA. The main outcome measurement was the development of septic shock and/or death.
  
  
  RESULTS
  Of 71 eligible subjects, nine (12.7%) progressed to septic shock and/or death. In the LONS-Non-Shock group, the sTREM-1 median and interquartile range (IQR) plasma value were 10 (10 to 70) pg/mL. In the LONS & Shock/Death group, the values were 567 (260 to 649) pg/mL. These values were significantly different (Mann-Whitney's U test, p=0.001). A ROC curve for a proposed sTREM-1 cut-off value of 300 pg/mL exhibited an area under the curve of 0.884 (95% CI=0.73 to 1.0; p<0.0001), with a sensitivity of 0.78 (95% CI=0.46 to 0.94) and specificity of 0.97 (95% CI=0.92 to 0.99); PPV would be 0.78 (95% CI=0.46 to 0.94) and NPV 0.97 (95% CI=0.92 to 0.99).
  
  
  CONCLUSIONS
  In neonates with LONS, sTREM-1 has the potential to provide an excellent predictive value for septic shock/death. Larger sample sizes are needed to identify the optimal cut-off value of plasma sTREM-1 for this diagnosis and to provide diagnostic accuracy measures.
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología.
authors.forename: Víctor
authors.initials: V
authors.lastname: Arízaga-Ballesteros
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología.
authors.forename: Mario René
authors.initials: MR
authors.lastname: Alcorta-García
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología.
authors.forename: Lizzeth Carolina
authors.initials: LC
authors.lastname: Lázaro-Martínez
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología.
authors.forename: Jesús Manuel
authors.initials: JM
authors.lastname: Amézquita-Gómez
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Alanís-Cajero
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina, Dirección de Investigación e Innovación.
authors.forename: Luis
authors.initials: L
authors.lastname: Villela
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina, Dirección de Investigación e Innovación.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Castorena-Torres
authors.affiliation: Tecnológico de Monterrey, Escuela de Medicina. Programa Multicéntrico de Residencias Médicas, Neonatología; Tecnológico de Monterrey, Escuela de Medicina, Dirección de Investigación e Innovación. Electronic address: lara-diaz.vj@itesm.mx.
authors.forename: Víctor Javier
authors.initials: VJ
authors.lastname: Lara-Díaz
mesh_terms: D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D010865:Pilot Projects; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000097:blood*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
keywords: Diagnosis; Diseases; Intensive care; Neonatal; Premature; ROC curve; Sensitivity and Specificity.; Sepsis