Diagnostic effectiveness of soluble triggering receptor expressed on myeloid cells-1 in sepsis, severe sepsis and septic shock

INTRODUCTION: Sensitivities and specificities of clinical signs and biochemical tests in sepsis diagnosis are not satisfactory. The aim of the study was to assess the diagnostic usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in sepsis, severe sepsis and septic shock against interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT). MATERIAL AND METHODS: A prospective, observational study was conducted in 85 adults with sepsis, severe sepsis or septic shock and 22 with non-infective systemic inflammatory response syndrome (NI-SIRS). Serum levels of sTREM-1, CRP, PCT and IL-6 were measured on admission. RESULTS: Median serum sTREM-1 concentrations were higher in severe sepsis (540 pg/ml) and septic shock (536 pg/ml) in comparison with NI-SIRS patients (p < 0.05). There were no differences in sTREM-1 levels between NI-SIRS and sepsis. Similarly, CRP, PCT and IL-6 were significantly elevated in patients with severe sepsis and septic shock in comparison with NI-SIRS. The receiver operating characteristic curve analysis for diagnosis of severe sepsis showed higher discriminative value for CRP and IL-6 (AUC = 0.909, 95% CI: 0.829–0.99 and AUC = 0.854, 95% CI: 0.728–0.980, respectively) than sTREM-1 (AUC = 0.733, 95% CI: 0.596–0.870). In septic shock the highest AUC was found for CRP (AUC = 0.938, 95% CI: 0.872–1.0), lower for IL-6 (AUC = 0.869, 95% CI: 0.751–0.987), PCT (AUC = 0.828, 95% CI: 0.71–0.945) and sTREM-1 (AUC = 0.705, 95% CI: 0.553–0.856). CONCLUSIONS: Serum level of sTREM-1 has lower effectiveness as a diagnostic biomarker in severe sepsis and septic shock, in comparison with CRP and IL-6.