Increased sTREM-1 levels identify cirrhotic patients with bacterial infection and predict their 90-day mortality - 28/10/21
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Highlights |
• | sTREM-1 is released from monocytes/macrophages and neutrophils during activation. |
• | Presence of bacterial infection (BI) and ACLF increases sTREM-1 levels. |
• | sTREM-1 and CRP identify BI among acute decompensated patients with similar accuracy. |
• | Combination of sTREM-1, CRP and ascites resulted in a superior composite score. |
• | High sTREM-1 level is an independent 90-day mortality predictor in patients with BI. |
Abstract |
Background and aims |
Patients with cirrhosis are susceptible to bacterial infections (BIs) that are major causes of specific complications and mortality. However, the diagnosis of BIs can often be difficult in advanced disease stage since their symptoms may overlap with the ones of acute decompensation (AD). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is released from monocytes/macrophages and neutrophils during activation and has been reported to correlate with activity of various inflammatory processes. We investigated its diagnostic and prognostic performance in patients with cirrhosis and BI.
Methods |
Sera of 269 patients were assayed for sTREM-1 by ELISA (172 outpatients and 97 patients with AD of whom 56 had BI). We investigated capacity of sTREM-1 to identify patients with BI and conducted a 90-day follow-up observational study to assess its possible association with short-term mortality.
Results |
sTREM-1 levels were significantly higher in patients with more severe liver disease, BI, and acute-on-chronic liver failure than in patients without these conditions. sTREM-1 had similar accuracy to CRP identifying BI [sTREM-1: AUROC (95%CI) 0.804 (0.711−0.897), p < 0.0001; CRP: 0.791 (0.702−0.881), p < 0.0001)] among AD patients. The combination of these two molecules and the presence of ascites into a composite score significantly increased their discriminative power (AUROC: 0.878, 95%CI: 0.812−0.944, p < 0.0001). High sTREM-1 level (>660 pg/mL) was an independent predictor of 90-day mortality in patients with BI [HR: 2.941, (95%CI: 1.009−8.573), p = 0.048] in our multivariate model.
Conclusions |
Use of sTREM-1 could increase the recognition of BIs in cirrhosis and help clinicians in mortality risk assessment of these patients.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ACLF, AD, ADI score, AKI, AUROC, BI, BT, CRP, HCC, HE, HR, ln, MELD, TREM-1, sTREM-1, -PV
Keywords : sTREM-1, Bacterial infection, Cirrhosis, Acute decompensation, Mortality
Mappa
Vol 45 - N° 5
Articolo 101579- Settembre 2021 Ritorno al numero
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