Özlem TÜNGER, Melek ÇİVİ, Çiğdem Banu ÇETİN, Gönül HORASAN DİNÇ, Münip Hakan YÜCEYAR, Halim BAYRAM, Cevvel ULMAN

Diagnostic and prognostic value of procalcitonin and sTREM-1 levels in sepsis

Background/aim: Sepsis is still a major cause of morbidity and mortality despite the improvements in diagnosis and treatment. The aim of this study was to investigate the values of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the differential diagnosis of patients with sepsis and noninfectious systemic inflammatory response syndrome (NI-SIRS) and measure their importance in the prognosis of patients with sepsis. Materials and methods: This prospective study included 41 NI-SIRS and 33 sepsis patients hospitalized in Celal Bayar University Hospital, Manisa, Turkey. Blood samples were taken from NI-SIRS patients on days 0 and 3 and from sepsis patients on days 0, 3, 4, 7, and 14. Clinical status of the patients was determined with the SOFA scoring system. Results: The SOFA scoring system and procalcitonin and sTREM-1 measurements were significant in the differential diagnosis of sepsis and NI-SIRS patients. The SOFA scoring system was considered the most important indicator in determining the prognosis of sepsis patients. Procalcitonin and sTREM-1 levels increased progressively in nonsurvivors and decreased in survivors, but changes were statistically insignificant. Conclusion: In the differentiation of sepsis and NI-SIRS, and evaluation of the prognosis of sepsis, combined measurements of procalcitonin and sTREM-1 levels are important.

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Balk RA. Severe sepsis and septic shock. Crit Care Clin 2000; 16: 179192.
Danai P, Martin GS. Epidemiology of sepsis: recent advances. Curr Infect Dis Rep 2005; 7: 329334.
Bloos F, Reinhart K. Rapid diagnosis of sepsis. Virulence 2013; 5: 219225.
Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin 2006; 22: 503519.
Vincent JL, Beumier M. Diagnostic and prognostic markers in sepsis. Expert Rev Anti Infect Ther 2013; 11: 265275.
6. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426435.
7. Samraj RS, Zingarelli B, Wong HR. Role of biomarkers in sepsis care. Shock 2013; 40: 358365.
8. Ford JW, McVicar DW. TREM and TREM-like receptors in inflammation and disease. Curr Opin Immunol 2009; 21: 38 46.
9. Wu Y, Wang F, Fan X, Bao R, Bo L, Li J, Deng X. Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: a systematic review and meta-analysis. Crit Care 2012; 16: R229.
10. Gibot S, Cravoisy A, Dupays C. Combined measurement of procalcitonin and soluble TREM-1 in the diagnosis of nosocomial sepsis. Scand J Infect Dis 2007; 39: 604608.
11. Marshall JC, Reinhart K. International Sepsis Forum: biomarkers of sepsis. Crit Care Med 2009; 37: 22902298.
12. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ; ACCP/SCCM Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest 2009; 136: e28.
13. Vincent JL, Moreno R. Clinical review: scoring systems in the critically ill. Crit Care 2010; 14: 207.
14. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC. Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2006.
15. Endo S, Aikawa N, Fujishima S, Sekine I, Kogawa K, Yamamoto Y, Kushimoto S, Yukioka H, Kato N, Totsuka K et al. Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study. J Infect Chemother 2008; 14: 244249.
16. Barati M, Bashar FR, Shahrami R, Zadeh MH, Taher MT, Nojomi M. Soluble triggering receptor expressed on myeloid cells-1 and the diagnosis of sepsis. J Crit Care 2010; 25: 362. e16.
17. Jiyong J, Tiancha H, Wei C, Huahao S. Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection: a meta-analysis. Intensive Care Med 2009; 35: 587595.
18. Schorr CA, Zanotti S, Dellinger RP. Severe sepsis and septic shock: management and performance improvement. Virulence 2014; 5: 226235.
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426435.
Kenzaka T, Okayama M, Kuroki S, Fukui M, Yahata S, Hayashi H, Kitao A, Sugiyama D, Kajii E, Hashimoto M. Importance of vital signs to the early diagnosis and severity of sepsis: association between vital signs and sequential organ failure assessment score in patients with sepsis. Intern Med 2012; 51: 871876.
Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol 2006; 72: 6980.
Innocenti F, Bianchi S, Guerrini E, Vicidomini S, Conti A, Zanobetti M, Pini R. Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit. Eur J Emerg Med 2013; (Epub): 16.
Kofoed K, Eugen-Olsen J, Petersen J, Larsen K, Andersen O. Predicting mortality in patients with systemic inflammatory response syndrome: an evaluation of two prognostic models, two soluble receptors, and a macrophage migration inhibitory factor. Eur J Clin Microbiol Infect Dis 2008; 27: 375383.
Gibot S, Cravoisy A, Kolopp-Sarda MN, Béné C, Faure G, Bollaert PE, Levy B. Time-course of sTREM (soluble triggering receptor expressed on myeloid cells)-1, procalcitonin, and C-reactive protein plasma concentrations during sepsis. Crit Care Med 2005; 33: 792796.
Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: Factors that influence disparities in sepsis. Crit Care Med 2006; 34: 2576 2582.