Clinical Value Of Serum Soluble Triggering Receptor Expressed On Myeloid Cells-1 (sTREM-1) In Bloodstream Infection

Objective:To investigate the diagnostic value of serum sTREM-1 in early bloodstream infections(BSI)and its clinical value in evaluating the severity and prognosis of bloodstream infection.Methods:Collection of The Affiliated hospital of north Sichuan medical college from October 2018 to November 2019 patients with various departments meet eligibility criteria and exclusion criteria,These patients were divided into the bloodstream infection group with 84 cases and the local infection group with 81 cases according to the result of blood culture;recording patients’ general information,constituting the basic diseases,other types of local infection and body temperature,blood routine,biochemical and serum PCT,serum sTREM-1,etc.;At the same time,whether acute or chronic renal insufficiency was associated with the course of disease in the bloodstream infection group,the use of antibiotics before the first blood collection,whether the bloodstream infection was community acquired or hospital acquired,the types of pathogenic bacteria in the blood culture results,and the disease outcome were recorded.At the same time,the bloodstream infection group was divided into the recovery group(50 patients)and the death group(9 patients)according to the prognosis of the patients when the discharged.The blood routine,serum PCT and serum sTREM-1 values of the recovery group were measured again on the 4th day of normal body temperature.The value of serum sTREM-1 was detected by ELISA,All data were analyzed by SPSS25.00 statistical software.Result:①Serum PCT,serum sTREM-1,body temperature,and percentage of neutrophil in the bloodstream infection group were significantly higher than those in the local infection group without bloodstream infection,with statistically significant differences(p<0.05).However,there was no significant difference in white blood cell count between the bloodstream infection and the local infection groups(p>0.05);②Using the receiver operating characteristic cure,the area under the ROC curve of serum sTREM-1 for the diagnosis of bloodstream infection was 0.735(p<0.001).When the cut-off value of serum sTREM-1 was 1174.72pg/ml,the Youden index was the largest,with a sensitivity of 61%and specificity of 80%.The area under the ROC curve of serum PCT in diagnosing bloodstream infection was 0.722(p<0.001),and when the cut-off value was 1.92ng/ml,the Youden index was the largest.At this point,the sensitivity was 62%,and the specificity was 70%.The diagnostic value of serum sTREM-1 and serum PCT in bloodstream infection is comparable;③The serum sTREM-1 and serum PCT values of the bloodstream infection group with renal insufficiency were higher than those of the non-renal insufficiency group;The serum sTREM-1 values of the group without antibiotics before the first blood collection were higher than those of the group with antibiotics;serum PCT values of the group without antibiotics were lower than those of the group with antibiotics;Serum sTREM-1 in the community acquired bloodstream infection group was higher than that in the hospital acquired bloodstream infection group,with statistically significant differences(p<0.05).There was no significant difference between serum sTREM-1 and serum PCT in various pathogenic bacterial bloodstream infections(p>0.05);④Serum PCT and serum sTREM-1 in the bloodstream infection death group were higher than those in the recovery group,and plasma albumin in the death group was lower than that in the recovery group,these differences were statistically significant(p<0.05).Multivariate logistic regression analysis showed that plasma albumin and serum sTREM-1 were independent risk factors for the prognosis of patients with bloodstream infection(p<0.05);⑤Serum sTREM-1 and serum PCT in the recovery bloodstream infection group decreased significantly after the condition improved compared with that into the control group,with statistically significant di fference(p<0.05).Conclusion:Serum PCT and serum sTREM-1 have certain diagnostic value for early bloodstream infection,and the diagnostic value of serum sTREM-1 is comparable with that of serum PCT;Serum PCT and serum sTREM-1 cannot be used to predict single bacterial bloodstream infection pathogenic types;Serum PCT,serum sTREM-1 and plasma albumin have certain predictive value for the severity,efficacy,prognosis and outcome of bloodstream infection,and plasma albumin and serum sTREM-1 are independent risk factors affecting the prognosis of patients with bloodstream infection.