Diagnostic value of bronchoalveolar lavage-fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) concentration for neonatal ventilator-associated pneumonia

Abstract

Background: Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has regarded as a biological marker of infection.We aimed to evaluate the diagnostic value of bronchoalveolar lavage (BAL)-sTREM-1 concentration in neonatal ventilator-associated pneumonia (NVAP).Methods: In this multicenter, controlled clinical trial of 60 preterm and 33 full-term neonates on mechanical ventilators, we measured concentrations of BAL-fluid and serum sTREM-1, serum C-reactive protein, and serum procalcitonin, as well as white blood cell count. We initially divided cases into eight groups, based on three categories: preterm of full-term; NVAP or non-NVAP; and extrapulmonary infection present or absent. Groups were compared, and logistic regression analysis and receiver operating characteristic (ROC) analysis was performed to determine diagnostic value.Results: The mean gestational age (± standard deviation) of preterm and full-term neonates was 28.9±2.2 weeks and 39.5±1.7 weeks, respectively, and 32/60 were male. The BAL-fluid sTREM-1 concentration was higher in NVAP cases than in non-NVAP cases, irrespective of extrapulmonary infection. ROC analysis revealed that BAL-fluid sTREM-1 concentration had an area under the curve (AUC) of 0.986 and a cutoff value of 228.0 pg/ml (sensitivity, 94.3%; specificity, 96%) in preterm neonates; the same values in full-term neonates were 0.938 and 245.5 pg/ml (sensitivity, 100%; specificity, 93.7%), respectively. The optimal combination of indicators was BAL-fluid sTREM-1 and serum C-reactive protein concentration. All indicators were present at lower levels on days 8 and 10 of ventilation in neonates who ultimately recovered than in those who did not. Conclusions: BAL-fluid sTREM-1 and serum C-reactive protein concentrations may be useful for the diagnosis of NVAP.Blinded manuscript textThe RCT was approved by the Ethics Review Committee ofThe First People's Hospital of Yongkang (number: ykyy201803). Furthermore, the study was registered in and approved by the Registration Centre of Clinical Trials in China (approval number: ChiCTR1900020564). URL of trial registry record:http://www.chictr.org.cn/showproj.aspx?proj=22336 Date of registration:2017-10-19