Diagnostic value of soluble triggering receptor expressed on myeloid cells in paediatric sepsis: a systematic review.
BACKGROUND
Differential diagnosis between sepsis and non-infectious inflammatory disorders demands improved biomarkers. Soluble Triggering Receptor Expression on Myeloid cells (sTREM-1) is an activating receptor whose role has been studied throughout the last decade. We performed a systematic review to evaluate the accuracy of plasma sTREM-1 levels in the diagnosis of sepsis in children with Systemic Inflammatory Response Syndrome (SIRS).


METHODS
A literature search of PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ISI Web of Knowledge databases was performed using specific search terms. Studies were included if they assessed the diagnostic accuracy of plasma sTREM-1 for sepsis in paediatric patients with SIRS. Data on sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic curve were extracted. The methodological quality of each study was assessed using a checklist based on the Quality Assessment Tool for Diagnostic Accuracy Studies.


RESULTS
Nine studies comprising 961 patients were included, four of which were in newborns, three in children and two in children with febrile neutropenia. Some data from single studies support a role of sTREM-1 as a diagnostic tool in pediatric sepsis, but cannot be considered conclusive, because a quantitative synthesis was not possible, due to heterogeneity in studies design.


CONCLUSIONS
This systematic review suggests that available data are insufficient to support a role for sTREM in the diagnosis and follow-up of paediatric sepsis.
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy. giuseppe.pontrelli@opbg.net.
Giuseppe
G
Pontrelli
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Franco
F
De Crescenzo
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Roberto
R
Buzzetti
Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Francesca
F
Calò Carducci
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.|Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Alessandro
A
Jenkner
Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Donato
D
Amodio
Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Maia
M
De Luca
Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Sara
S
Chiurchiù
Paediatric European Network for Treatment of AIDS, Via Giustiniani 3, 35128, Padova, Italy.
Elin Haf
EH
Davies
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.|Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Alessandra
A
Simonetti
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Elena
E
Ferretti
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Martina
M
Della Corte
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Luca
L
Gramatica
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Susanna
S
Livadiotti
Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.|Immunological and Infectious Disease Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
Paolo
P
Rossi
D015415:Biomarkers / Q000097:blood; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D008562:Membrane Glycoproteins / Q000097:blood*; D022423:Myeloid Cells; D011971:Receptors, Immunologic / Q000097:blood*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis*; 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
Children; Neonates; Review; Sepsis; Systematic; Triggering receptor expressed on myeloid cells-1