Can sTREM-1 predict septic shock &amp; death in late-onset neonatal sepsis? A pilot study

Arízaga-Ballesteros, Víctor; Alcorta-García, Mario René; Lázaro-Martínez, Lizzeth Carolina; Amézquita-Gómez, Jesús Manuel; Alanís-Cajero, José Manuel; Villela, Luís; Castorena‐Torres, Fabiola; Díaz, Víctor J.

doi:10.1016/j.ijid.2014.10.013

Cited by 31 publications

(21 citation statements)

References 29 publications

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“…e impact on practice can be through training to improve knowledge and skills in management of paediatric septic shock using SSCG 2012. e information obtained from this study done globally. A study by Arizaga-Ballesteros et al in two Mexican hospitals showed the prevalence of neonatal shock admitted to NICU to be 12.7% of all neonatal admissions [22]. e reasons for high neonatal prevalence of septic shock in this study were not explored but may be due to poor health seeking behaviour, negative traditional beliefs or poor maternal education on neonatal danger signs as seen from a study done locally by Michieka et al (unpublished).…”

Section: Audit Of Management Of Septic Shock Atmentioning

confidence: 66%

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

Vekaria-Hirani

Kumar

Musoke

et al. 2019

International Journal of Pediatrics

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Background. Paediatric septic shock is a subset of sepsis associated with high mortality. Implementing the existing international Surviving Sepsis Campaign Guidelines 2012 (SSCG) have contributed to reduction of mortality in many places but these have not been adopted in our setting. The current study aimed at documenting the practice at a national referral hospital. Methods. A hospital based longitudinal survey carried out among 325 children from September to October 2016. Children aged 0 days (≥37 weeks gestation) to12 years were included. The aim was to determine the prevalence, audit the management and determine the outcome at 72 hours of septic shock among children admitted at the Kenyatta National Hospital (KNH). A standard questionnaire was used for data collection and Surviving Sepsis Guideline 2012 was used as a reference for auditing the management of septic shock. Data was stored in MS-EXCEL and analysed in STATA 12. Results. The prevalence of septic shock was 50 (15.4%), with a median age of 4 months. Septic shock was recognized by the attending clinician in 28 (56%). The level of care to children with septic shock was not to the level recommended by the SSCG 2012. Odds of being diagnosed with septic shock reduced with age (odds ratio 4.38 (1.7–11.0), p=0.002) and no child aged above 60 months age was diagnosed with septic shock. The mortality was 35 (70%) at 72 hours of admission, with a median of 14 hours. Infants had the highest case fatality of 82.6%. It was found that lack of mechanical ventilation, and presence of hypotension at admission were associated with greater mortality (p values of 0.03 and 0.01 respectively). Conclusion. The prevalence rate of septic shock is 15.4% among children admitted at the KNH and is associated with high mortality. The advanced degree of shock contributed to mortality. The level of care at KNH was not to the level of SSCG 2012, and hence the need to include septic shock management guidelines/protocols in our local Kenyan paediatric guideline.

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Section: Audit Of Management Of Septic Shock Atmentioning

confidence: 66%

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

Vekaria-Hirani

Kumar

Musoke

et al. 2019

International Journal of Pediatrics

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“…59 A pilot study has suggested that sTREM1 can also be used as a prognostic marker, with higher levels being strongly predictive of septic shock and death. 60 Conserving blood volume is often a concern in the vulnerable preterm population, and another recent study suggests that urinary sTREM1 levels can also be used to predict NS, with sensitivity and specificity of 90% and 78%, respectively, when a cutoff value of 78.5 pg/mL was used. 61 Further work needs to be performed to better characterize appropriate cutoff values for infants of different GA and postnatal ages.…”

Section: Cd64mentioning

confidence: 99%

<p>Neonatal sepsis biomarkers: where are we now?</p>

Gilfillan¹,

Bhandari²

2019

RRN

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Given that neonatal sepsis remains an important factor contributing to mortality and morbidity in neonates, identification of accurate biomarkers to aid in its timely and accurate diagnosis is critical. In this review, we discuss the current evidence behind the use of biomarkers commonly used in clinical practice, as well as presenting recent developments in this area of research. Besides summarizing information regarding "traditional" biomarkers (eg, hematological indices, CRP, and other acute-phase reactants, cytokines), we provide the latest clinical status on some relatively "newer" biomarkers (eg, PCR-and "-omic" technology-based, biophysical biomarkers) in the diagnosis of neonatal sepsis. We believe that certain biophysical (RALIS, core-peripheral temperature differences) in combination with selective biochemical (procalcitonin, nCD64, presepsin) markers offer the best likelihood of being adopted for clinical use in the detection of neonatal sepsis in the near future. In addition, serial measurements of selective biochemical markers (procalcitonin, nCD64) offer promise in the decision to initiate and/or control the duration of antibiotic therapy. It is important to conduct adequately powered prospective multicenter studies to continue to establish the accuracy and safety of utilizing such biomarkers of neonatal sepsis so that appropriate and adequate therapy is tailored to each infant for optimal outcomes.

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“…It is a marker of neonatal sepsis 11 and predicts shock and death. 12 sTREM-1 and its gene polymorphisms are also associated with sepsis prognosis 13 and high sTREM-1 is predictive of Systemic Inflammatory Response Syndrome (SIRS) 14 after surgery. TREM-1 and its soluble form are therefore potential diagnostic markers for infectious and chronic inflammatory diseases and also potential future targets for therapeutic manipulation.…”

Section: Introductionmentioning

confidence: 99%

Reversal of TREM-1 ectodomain shedding and improved bacterial clearance by intranasal metalloproteinase inhibitors

et al. 2017

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Triggering receptor expressed on myeloid cells-1 (TREM-1) is expressed on neutrophils and monocyte/macrophages and amplifies Toll-like receptor-mediated inflammation during infection. TREM-1 also exists in an antagonistic soluble form (sTREM-1) that has been used as a peripheral biomarker in sepsis, though the mechanisms of its release are not entirely clear. The requirement of TREM-1 in single microbial infections is controversial, with some studies showing a protective role and others a contribution to immunopathology. Furthermore, the role of membrane-bound and sTREM-1 in polygenic infections is currently unknown. In a mouse co-infection model where preceding viral infection greatly enhances bacteria co-infection, we now determine a mechanisms for the striking increase in sTREM-1 and the loss of TREM-1 on surface of neutrophils. We identified a matrix metalloproteinase (MMP)-9 cleavage site in TREM-1 and that the increase of MMP-9 in bronchoalveolar lavage fluid mirrors sTREM-1 release. In vitro studies with neutrophils and MMP-9 and the reduction of sTREM-1 in vivo after MMP-9 inhibition verifies that this enzyme cleaves TREM-1. Intriguingly, MMP-9 inhibition significantly reduces bacterial load and ensuing immunopathology in a co-infection model. This highlights MMP-9 inhibition as a potential therapeutic via blocking cleavage of TREM-1.

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Can sTREM-1 predict septic shock & death in late-onset neonatal sepsis? A pilot study

Abstract: 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.

Cited by 31 publications

References 29 publications

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

<p>Neonatal sepsis biomarkers: where are we now?</p>

Reversal of TREM-1 ectodomain shedding and improved bacterial clearance by intranasal metalloproteinase inhibitors

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