title: sTREM-1 predicts intensive care unit and 28-day mortality in cancer patients with severe sepsis and septic shock.
abstract: BACKGROUND
  The innate immune response molecules and their use as a predictor of mortality in cancer patients with severe sepsis and septic shock are poorly investigated.
  
  
  OBJECTIVE
  To analyze the value of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor α (TNF-α), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and high-mobility group box 1 (HMGB-1) as predictors of mortality in cancer patients with severe sepsis and septic shock compared with septic patients without malignancies.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Tertiary level adult intensive care unit (ICU).
  
  
  METHODS
  Seventy-five patients with severe sepsis or septic shock, 40 with cancer and 35 without.
  
  
  METHODS
  Laboratory data were collected at ICU admission, 24 and 48 hours after. Plasma concentrations of HMGB-1 and sTREM-1 were measured by enzyme-linked immunosorbent assay, whereas cytokines were measured by cytometric bead array.
  
  
  RESULTS
  Intensive care unit mortality in cancer and noncancer patients was 40% and 28.6% (P = .29), and 28-day mortality was 45% and 34.3% (P = .34). Proinflammatory cytokines IL-1ß, IL-6, IL-8, IL-12, and TNF-α showed significantly higher values in the cancer group. Interleukin-10 at 48 hours (P = .01), sTREM-1 in all measurements (P < .01) and HMGB-1 at 24 hours (P < .01) showed significantly lower values in the cancer group. In addition, for the cancer group, sTREM-1 at 24 hours (P = .02) and 48 hours (P = .01) showed higher levels in nonsurvivors patients. The area under the receiver operating characteristic curve for predicting ICU mortality for sTREM-1 was 0.73 (95% confidence interval, 0.57-0.89; P = .01). Multivariate logistic analysis showed that the days spent in mechanical ventilation and levels of sTREM-1 and IL-1ß at 48 hours were independent predictors of ICU mortality; corticosteroids requirement and levels of sTREM-1 and TNF-α at 24 hours were independent predictors of 28-day mortality.
  
  
  CONCLUSIONS
  Patients with cancer have different immune profile in sepsis when compared with patients without cancer, as demonstrated for levels of cytokines, sTREM-1 and HMGB-1. sTREM-1 and days spent in mechanical ventilation proved to be good predictors of ICU and 28-day mortality in cancer patients.
authors.affiliation: Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil; ICU of Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil. Electronic address: ceciliag.ravetti@gmail.com.
authors.forename: Cecilia Gómez
authors.initials: CG
authors.lastname: Ravetti
authors.affiliation: ICU of Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Anselmo Dornas
authors.initials: AD
authors.lastname: Moura
authors.affiliation: Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil; Interdisciplinary Laboratory of Medical Investigation, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Érica Leandro
authors.initials: ÉL
authors.lastname: Vieira
authors.affiliation: Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ênio Roberto Pietra
authors.initials: ÊR
authors.lastname: Pedroso
authors.affiliation: Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil; Interdisciplinary Laboratory of Medical Investigation, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Antônio Lúcio
authors.initials: AL
authors.lastname: Teixeira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D024243:HMGB1 Protein / Q000097:blood*; D006801:Humans; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000097:blood*; D012121:Respiration, Artificial; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000401:mortality; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000401:mortality; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10
keywords: Cancer; Cytokines sTREM-1; HMGB-1; Intensive care unit; Septic shock; Severe sepsis