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ARTICLE

Plasma Level of a Triggering Receptor Expressed on Myeloid Cells-1: Its Diagnostic Accuracy in Patients with Suspected Sepsis

Sébastien Gibot, MD; Marie-Nathalie Kolopp-Sarda, PharmD, PhD; Marie C. Béné, PharmSci, PhD; Aurélie Cravoisy, MD; Bruno Levy, MD, PhD; Gilbert C. Faure, MD, PhD; and Pierre-Edouard Bollaert, MD, PhD

6 July 2004 | Volume 141 Issue 1 | Pages 9-15

Background: Previous experimental studies have suggested that the triggering receptor expressed on myeloid cells-1 (TREM-1) is specifically upregulated in the presence of microbial products.

Objective: To evaluate the diagnostic value of plasma levels of the soluble form of TREM-1 in patients admitted with clinical suspicion of infection.

Design: Prospective, noninterventional study conducted between July and September 2003.

Setting: Medical adult intensive care unit at a university hospital in France.

Participants: 76 consecutive newly admitted patients who presented with clinically suspected infection and fulfilled at least 2 criteria of the systemic inflammatory response syndrome.

Measurements: Sensitivity and specificity of plasma soluble TREM-1 levels at admission for the diagnosis of infection. Two independent intensivists blinded to the results of soluble TREM-1 assays retrospectively classified patients as having the systemic inflammatory response syndrome, sepsis, severe sepsis, or septic shock.

Results: The systemic inflammatory response syndrome was diagnosed in 29 patients (38%), and sepsis, severe sepsis, or septic shock was diagnosed in the remaining 47 (62%). A plasma soluble TREM-1 level higher than 60 ng/mL was more accurate than any other clinical or laboratory finding for indicating infection (sensitivity, 96% [95% CI, 92% to 100%]; specificity, 89% [CI, 82% to 95%]; positive likelihood ratio, 8.6 [CI, 3.8 to 21.5]; negative likelihood ratio, 0.04 [CI, 0.01 to 0.2]).

Limitations: The study did not enroll patients with mild infections not requiring intensive care unit hospitalization, patients older than 80 years of age, or patients who were immunocompromised.

Conclusion: In newly admitted critically ill patients, measurement of plasma levels of soluble TREM-1 could help to rapidly identify those with infection.

Editors' Notes Context Exposure to bacteria upregulates an immunoglobulin-like molecule on phagocytes called the triggering receptor expressed on myeloid cells-1 (TREM-1). Can TREM-1 help distinguish sepsis from the systemic inflammatory response syndrome (SIRS) without infection? Contribution In this prospective study, 76 critically ill adults with suspected infection had plasma TREM-1 levels measured with a rapid immunoblot technique. Thirty-eight percent of the adults had SIRS, and 62% had sepsis. A TREM-1 level higher than 60 ng/mL increased the odds of sepsis by 8.6 (95% CI, 3.8 to 21.5). Implications Levels of TREM-1 may help diagnose bacterial sepsis in critically ill patients. –The Editors

 

Author and Article Information

From Hôpital Central, Nancy, and Faculté de Médecine, Vandoeuvre-les-Nancy, France.

Acknowledgments: The authors thank Dr. Marco Colonna for providing anti–TREM-1 antibody and the nursing staff of the intensive care unit for their compliance with the study protocol.

Grant Support: By the Programme Hospitalier de Recherche Clinique, 2000–2003, and by the French Ministère de la Recherche et de la Technologie (grant EA3443).

Potential Financial Conflicts of Interest:Grants received: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, G.C. Faure (Programme Hospitalier de Recherche Clinique, French Ministère de la Recherche et de la Technologie).

Requests for Single Reprints: Sébastien Gibot, MD, Hôpital Central, Service de Réanimation Médicale, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.

Current Author Addresses: Drs. Gibot, Cravoisy, Lévy, and Bollaert: Hôpital Central, Service de Réanimation Médicale, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.

Drs. Kolopp-Sarda, Béné, and Faure: Laboratoire d'Immunologie, Faculté de Médecine, Avenue du Foret de Haye, 54500 Vandoeuvre-les-Nancy, France.

Author Contributions: Conception and design: S. Gibot, M.-N. Kolopp-Sarda, B. Levy, P.-E. Bollaert.

Analysis and interpretation of the data: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, A. Cravoisy, B. Levy, P.-E. Bollaert.

Drafting of the article: S. Gibot, M.C. Béné, P.-E. Bollaert.

Critical revision of the article for important intellectual content: M.C. Béné, A. Cravoisy, B. Levy, G.C. Faure, P.-E. Bollaert.

Final approval of the article: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, A. Cravoisy, B. Levy, G.C. Faure, P.-E. Bollaert.

Provision of study materials or patients: S. Gibot, A. Cravoisy, B. Levy.

Statistical expertise: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, B. Levy, G.C. Faure.

Obtaining of funding: M.-N. Kolopp-Sarda, M.C. Béné, G.C. Faure.

Administrative, technical, or logistic support: M.-N. Kolopp-Sarda, A. Cravoisy, G.C. Faure.

Collection and assembly of data: S. Gibot, B. Levy.

Related articles in Annals:

Summaries for Patients
A Possible New Test for Diagnosing Sepsis

Annals 2004 141: I-46. [Full Text]  

Letters
Correction: Plasma Level of a Triggering Receptor Expressed on Myeloid Cells-1

Annals 2005 142: 592. [Full Text]  

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