Open AccessExpression of the triggering receptor expressed on myeloid cells‐1 mRNA in a heterogeneous infected population
Author(s) -
How C.K.,
Chern C.H.,
Wu M.F.,
Wang L.M.,
Huang C.I.,
Lee C.H.,
Hsieh S.L.
Publication year - 2009
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/j.1742-1241.2006.01193.x
Subject(s) - medicine , sepsis , receiver operating characteristic , systemic inflammatory response syndrome , gastroenterology , confidence interval , myeloid , receptor , messenger rna , likelihood ratios in diagnostic testing , prospective cohort study , area under the curve , immunology , gene , biology , biochemistry
Summary This study is to investigate the clinical utility of detection of peripheral blood triggering receptor expressed on myeloid cells (TREM)‐1 mRNA as an early indicator of sepsis among critically ill patients and to compare the results of TREM‐1 with those of C‐reactive protein (CRP). A prospective, non‐interventional study of 127 patients with at least two criteria of the systemic inflammatory response (SIRS) was performed. TREM‐1 was assessed by real‐time quantitative reverse transcription‐polymerase chain reaction. The diagnosis of SIRS only was made in 41 patients (32%), and the diagnosis of sepsis was made in other 86 patients (68%). TREM‐1 mRNA expression had the comparably discriminative value to differentiate the presence from the absence of infection, with an area under the receiver‐operating characteristic curve ( AUC ) of 0.75 [95% confidence interval (95% CI), 0.67–0.84] than CRP [ AUC , 0.72 (95% CI, 0.62–0.81)]. As an indicator of sepsis, a TREM‐1 mRNA expression ratio cutoff value of 58.8 had a sensitivity of 72%, a specificity of 71%, a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.39. Furthermore, TREM‐1 mRNA expression was selectively higher in septic patients caused by extracellular bacteria or fungi [112.4 (19.3–680.1)], than in those caused by intracellular bacteria or viruses [18.8 (7.6–53.0), p < 0.001]. There was no difference in plasma CRP levels between both septic groups (p = 0.782). TREM‐1 and CRP are similar diagnostic markers of sepsis. The different ability of extracellular and intracellular pathogens to induce TREM‐1 expression may provide a potential marker for differential diagnosis.