The relationship between the expression of serum IL-18 mRNA, CC16, and sTREM-1 and the severity and prognosis of ventilator-associated pneumonia in elderly patients

Abstract

Background: This study aimed to explore the relationship between the severity and prognosis of elderly patients with ventilator-associated pneumonia (VAP) and the expression of serum interleukin-18 mRNA (IL-18 mRNA), Clara cell secretory protein 16 (CC16) and the soluble triggering receptor expressed on myeloid cells 1 (sTREM-1). Methods:The patients were divided into a VAP group (n=75) and a non-VAP group (n=110). According to the Acute Physiology and Chronic Health Evaluation II (APACHEII) score, the patients with VAP were divided into a low-risk group, an intermediate-risk group and a high-risk group. According to the 28-day outcome, the patients were divided into a survival group and a death group. Serum levels of IL-18, CC16 and sTREM-1 were detected, and their value in the prediction and prognosis of VAP was analyzed using a receiver operating characteristic (ROC) curve.Results: Serum levels of IL-18 and sTREM-1 in the VAP group were higher than those in the non-VAP group, while CC16 levels were lower in the VAP group than those in the non-VAP group (P<0.05). Serum levels of IL-18 and sTREM-1 decreased in order from the high-risk group to the intermediate-risk group to the low-risk group, while CC16 levels increased in order (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis of VAP with serum IL-18 mRNA, CC16 and sTREM-1 were 0.710 and 0.930, which were higher than those of single diagnosis (P<0.05). Serum levels of IL-18 mRNA and sTREM-1 in the survival group were lower than those in the death group, and the CC16 level was higher than that in the death group (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis with serum IL-18 mRNA, CC16 and sTREM-1 were 0.506 and 0.731, which were higher than those of single diagnosis (P<0.05). Conclusions:The combination of these 3 factors is of high value in predicting the severity and prognosis of VAP and can provide reference for clinical treatment.

Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients

“…There was no association between Glasgow score and urgent intubation with the development of VAP (P = .59). The median SOFA score in the first 24 hours was 6 points (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) in the VAP group versus 6 (0-14) in the non-VAP group, without a statistically significant difference (P = .49) and the median SOFA score at 48 hours was 6.5 points (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) in the VAP group versus 7 (0-14) in the non-VAP group, without a statistically significant difference (P = .44) (See Table 1). The median APACHE II score in the first 24 hours was 16.5 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) in the VAP group versus 17 in the non-VAP group, without a statistically significant difference (P = .54).…”

“…VAP was identified in 16 patients (37.2%) of the total population with neurocritical diseases. The severity of neurocritical disease was evaluated using the Glasgow score, SOFA score, and APACHE II score; and the median Glasgow score in the total population was 7 points (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In 36 patients (83.7%) the Glasgow score was less than 8 at the time of ward admission and required urgent intubation.…”

“…[16] Procalcitonin, C-reactive protein, sTREM-1, and HRC have proven to be predictors of VAP; however, most are markers of inflammation, making them nonspecific. [9–11,13,14,16]…”

“…[16] Procalcitonin, C-reactive protein, sTREM-1, and HRC have proven to be predictors of VAP; however, most are markers of inflammation, making them nonspecific. [9][10][11]13,14,16] Recently, the α-amylase concentration in tracheal secretions and bronchoalveolar lavage has been reported as a potentially useful marker for diagnosing microaspiration and bacterial pneumonia. [3,5,17] This marker is inexpensive and easily measured and could be an attractive marker for predicting the development of early VAP.…”

“…[4] Currently, there are no validated biomarkers for VAP diagnosis. Several biomarkers have been studied to predict the severity and prognosis of VAP, such as interleukin-18 (IL-18) and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), [9,10] histidine-rich glycoprotein, [11] pentraxin 3, [12] procalcitonin, [13,14] breath octane, acetaldehyde, [15] and C-reactive protein. [16] Procalcitonin, C-reactive protein, sTREM-1, and HRC have proven to be predictors of VAP; however, most are markers of inflammation, making them nonspecific.…”