| Background: Sepsis is a major factor contributing to ICU admissions and patientdeaths. Because of its rapid progression, the disease might, within a relatively shortperiod of time, lead to secondary multiple organ dysfunction syndromes and endangera patient’s life. Clinical practice has shown that for patients with severe sepsis, anearly, effective intervention can clearly improve prognosis and reduce mortality.Trauma, burns, pancreatitis, major surgery may elicit clinical signs of systemicinflammatory response syndrome(SIRS) in the absence of microbial infection.Themain indicators used for the early diagnosis in clinic were lacked of specificity, andthe costing time for results of blood culture needed2-3days. Moreover,cultures maybe negative especially in cases of antibiotic pre-treatment or inadequate sampling.Forthis reason, it is clinically important to identify indicators that can be used for theearly diagnosis and prognosis. The triggering receptor expressed on myeloid cells(TREM-1) is a member of the immunoglobulin super family, sTREM-1is a solubleform of TREM-1. An increasing number of studies indicate that there are increasedlevels of sTREM-1in body fluid samples for the following diseases and conditions:pneumonia, pleural effusion, septic arthritis, meningitis, peritonitis and uterine cavityinfection. This suggests that sTREM-1may be a valuable diagnostic indicator formaking distinctions between infectious and non-infectious diseases.Objective: To evaluate the diagnostic value of serum and urine sTREM-1for patientswith sepsis.Methods:1. Eighty-four patients with SIRS admitted into Intensive care unit from December2010to December2012were enrolled in our study. Groupings were divided accordingto infection or not and survival situation in28days.2. Levels of serum and urine Strem-1,PCT and CRP were measured by sandwichenzyme-linked immunosorbent assay, immunofluorescence and turbidimetric assay respectively on1h、1d、3d、5d、7d and14d.3. Sex, age, APACHE II score, the number of ventilation and WBC were recorded.4. SPSS16.0software is used for statistical analysis. Indicators to diagnosis weremanaged by receiver operating characteristic (ROC). The risk factors were analyzedby univariate and multivariate logistic regression analysis.Results:1. There are no differences in age, gender, APACHE II score, the number ofventilation and WBC between SIRS group（twenty-eight patients） and sepsis group（fifty-six patients）, and the levels of serum and urine Strem-1, PCT and CRP wereenhanced in sepsis group. The area under ROC curve of the levels of serum and urineStrem-1, PCT and CRP to diagnosis sepsis were0.894,0.800,0.722and0.692.2. The levels of APACHE II score, WBC, serum and urine Strem-1, PCT and CRPwere enhanced in death group（twenty-three patients） at1h. At the following1d、3d、5d、7d and14d., serum and urine Strem-1, PCT and CRP s were all increased in deathgroup. Univariate logistic regression analysis showed APACHE II score, serum andurine Strem-1, PCT and CRP were risk factors, and multivariate logistic regressionanalysis showed APACHE II score, serum and urine Strem-1were risk factorsindependently.Conclusion:1. The value of Strem-1in blood and urine for sepsis diagnostic were better than CRPand PCT, and The value of Strem-1in urine for sepsis diagnostic was worse thanserum Strem-1.2. APACHE II score, serum and urine Strem-1, PCT and CRP were risk factors forpatients with sepsis, but only APACHE II scores, serum and urine Strem-1were riskfactors independently. Background: Acute kidney injury (AKI) is well known to be associated with longerlength of stay, morbidity and mortality in adults. Sepsis-related kidney failure occursin about20-26%of sepsis patients. This incidence may be higher among severe sepsispatients, with a mortality rate of35-70%. An early, effective intervention can clearlyimprove sepsis-related kidney failure prognosis and reduce mortality. The mainindicators used for the early sepsis-related kidney failure diagnosis in clinic were SCrand urine output, they are lacked of specificity and can not reflect glomeruar filtrationrate in time. Serum cystatin C is a new indicators for kidney failure diagnosis in clinic.We have proved in first part that blood and urine sTREM-1can be used as indicator sfor making distinctions between infectious and non-infectious diseases. In case ofsepsis, systemic inflammatory factor-induced immune reactions, causing epithelialand endothelial cell injury, and induce changes in the glomerular pore diameter andcharge barrier, then inflammatory mediators were produced. So levels of sTREM-1inblood and urine may be valuable diagnostic indicators for sepsis-related kidneyfailure.Objective: To evaluate the diagnostic value of blood and urine sTREM-1for patientswith sepsis-related kidney failure.Methods:1. Fifty-six patients with sepsis admitted into Intensive care unit from December2010to December2012were enrolled in our study. Groupings were divided according tosepsis-related kidney failure or not and survival situation in28days.2. Levels Strem-1of in blood and urine, SCr and serum cystatin C were measured bysandwich enzyme-linked immunosorbent assay and automatic biochemical analyzeron1h and following every24h.3. Sex, age and urine output were recorded. SPSS16.0software is used for statistical analysis. Indicators to diagnosis were managed by receiver operating characteristic(ROC). The risk factors were analyzed by univariate and multivariate logisticregression analysis.Results:1. There were27patients occurred sepsis-related kidney failure during48h, and29patients not.There are no differences in age and gender between sepsis+AKI groupand sepsis group. The levels of sTREM-1in blood and urine, SCr, serum cystatin C atdiagnosis were enhanced in sepsis+AKI group, and urine output at diagnosis wasdecreased in sepsis+AKI group. Sepsis+AKI group showed higher mortality rate thansepsis group (55.6%VS17.2%).2. The area under ROC curve of the levels of sTREM-1in blood and urine, SCr, urineoutput and serum cystatin C to diagnosis sepsis-related kidney failure were0.793，0.812,0.732，0.263and0.764. It meant the levels of sTREM-1in blood and urinewere better on diagnosis sepsis-related kidney failure.3. Univariate logistic regression analysis showed the levels of sTREM-1in blood andurine, SCr, serum cystatin C and urine output were risk factors for sepsis-relatedkidney failure, and multivariate logistic regression analysis showed the levels ofsTREM-1in blood and urine and serum cystatin C were risks factor independently.Conclusion:1. The value of blood and urine Strem-1for sepsis-related kidney failure diagnosticwere better than SCr, serum cystatin C and urine output.2. The levels of sTREM-1in blood and urine, SCr, serum cystatin C and urine outputwere risk factors for sepsis-related kidney failure, but only the levels of sTREM-1inblood and urine and serum cystatin C were risk factors independently. |
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