Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study

Abstract

BackgroundThe diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery.MethodsThis was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1.ResultsThirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).ConclusionMeasurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study

“…Another study evaluating the prognostic value of sTREM-1 in patients with lung diseases claimed that sTREM-1 is a powerful biomarker reflecting clinical outcome [25]. However, a conflicting result was reported by a previous study that assessed the predictive value of sTREM-1 in pediatric patients with VAP and found no difference in serum and bronchoalveolar lavage sTREM-1 concentrations between the VAP and non-VAP groups [26]. There are several possible reasons for the discrepant findings between this previous study and our present study.…”

New parameters for childhood ventilator associated pneumonia diagnosis

“…They assessed the microbiological culture and s-TREM from the BALF collected via feeding tube and they could not find s-TREM levels effective in VAP diagnosis; however, s-TREM levels above 20.58 pg/ml were found to be helpful in VAP diagnosis with a sensitiviy of 50% and specificity of 86% in exhaled ventilator condensate. 24 Different cutoff values and contradictory opinions were reported in studies and we have limited knowledge in pediatric age group. It is 2 Clinical Pulmonary Infection Score.…”

“…22,23 It should be stated that there are only limited number of studies about the efficiency of s-TREM in diagnosing VAP in childhood. 24,25 In this study, BAL sample was obtained via nonbronchoscopic method from the children with suspected VAP and s-TREM-1 levels were measured and compared with control group in order to determine its value in VAP diagnosis. Besides we measured the blood levels of PCT and calculated CPIS scores, then we assessed the effects of these variables in diagnosing VAP.…”

Diagnostic value of bronchoalveolar lavage-fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) concentration for neonatal ventilator-associated pneumonia

“…sTREM-1 can be measured directly in human body uids, including serum, pleural effusion, sputum, and urine, during infections [14,17]. The concentration of sTREM-1 has been demonstrated to rise in the BAL uid of VAP patients [6,[18][19][20], including a pediatric research of VAP patients after cardiac surgery, but none about neonatal VAP [21].…”