Respiratory medicine · 2025
Soluble sTREM-1 as a prognostic biomarker of mortality in ventilator-associated Pneumonia: A prospective observational study.
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Aladakatti Aishwarya Revanesh, Jayaraj Biligere Siddaiah, Sindaghatta Chaya Krishnarao, Komarla Lokesh Sundararaja, Suhail A K, Greeshma Mandya Venkateshmurthy, Karnik Medha, Shamnaz S, Kumar Venkatesh, Vasanthan Vivek, Madhunapantula SubbaRao V, Padukudru Mahesh Anand
Аннотация
BACKGROUND: Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality in intensive care units (ICUs). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), an inflammatory amplifier released by activated neutrophils and monocytes, has emerged as a potential biomarker for infection severity. However, its prognostic value in VAP remains underexplored.
METHODS: In this prospective observational study conducted at a tertiary care ICU in southern India, 80 adult patients diagnosed with VAP (per CDC criteria) were enrolled, including 40 survivors and 40 non-survivors. Clinical data, APACHE II scores, inflammatory markers (CRP, procalcitonin, D-dimer, albumin), and oxygenation indices were recorded. Serum sTREM-1 levels were measured within 24 h of VAP diagnosis using ELISA. Statistical analysis included ROC curves, Cox regression, and Kaplan-Meier survival analysis.
RESULTS: Non-survivors had significantly higher sTREM-1 levels compared to survivors (17.3 ± 11.2 vs. 7.2 ± 7.2 pg/mL, p < 0.001). sTREM-1 levels positively correlated with CRP, D-dimer, and APACHE II, and negatively with PaO2/FiO2 and albumin. ROC analysis showed sTREM-1 (AUC 0.800) had strong prognostic accuracy, comparable to APACHE II (AUC 0.825). Notably, combining sTREM-1 with APACHE II improved the AUC to 0.945, outperforming combinations with CRP. Survival was significantly lower in patients with sTREM-1 >9.5 pg/mL (mean 20.8 vs. 51.2 days, p < 0.001).
CONCLUSION: sTREM-1 is a promising early prognostic biomarker in VAP, with additive value over established scoring systems. Its integration with clinical severity scores may enhance risk stratification and guide ICU decision-making.
METHODS: In this prospective observational study conducted at a tertiary care ICU in southern India, 80 adult patients diagnosed with VAP (per CDC criteria) were enrolled, including 40 survivors and 40 non-survivors. Clinical data, APACHE II scores, inflammatory markers (CRP, procalcitonin, D-dimer, albumin), and oxygenation indices were recorded. Serum sTREM-1 levels were measured within 24 h of VAP diagnosis using ELISA. Statistical analysis included ROC curves, Cox regression, and Kaplan-Meier survival analysis.
RESULTS: Non-survivors had significantly higher sTREM-1 levels compared to survivors (17.3 ± 11.2 vs. 7.2 ± 7.2 pg/mL, p < 0.001). sTREM-1 levels positively correlated with CRP, D-dimer, and APACHE II, and negatively with PaO2/FiO2 and albumin. ROC analysis showed sTREM-1 (AUC 0.800) had strong prognostic accuracy, comparable to APACHE II (AUC 0.825). Notably, combining sTREM-1 with APACHE II improved the AUC to 0.945, outperforming combinations with CRP. Survival was significantly lower in patients with sTREM-1 >9.5 pg/mL (mean 20.8 vs. 51.2 days, p < 0.001).
CONCLUSION: sTREM-1 is a promising early prognostic biomarker in VAP, with additive value over established scoring systems. Its integration with clinical severity scores may enhance risk stratification and guide ICU decision-making.