Limits...
Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study.

Matsuno AK, Carlotti AP - BMC Cardiovasc Disord (2013)

Bottom Line: Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP.However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group.In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. apcarlotti@fmrp.usp.br.

ABSTRACT

Background: The diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery.

Methods: This was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1.

Results: Thirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).

Conclusion: Measurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

Show MeSH

Related in: MedlinePlus

Serum concentrations of soluble triggering receptor expressed on myeloid cells (sTREM)-1. A. Daily log-transformed serum concentrations of sTREM-1 in the ventilator-associated pneumonia (VAP) group (white boxes) and in the non-VAP group (boxes with gray shading). B. Serum concentrations of sTREM-1 in the VAP group on the day before VAP diagnosis (D-1), on the day of VAP diagnosis (D0) and on the day after VAP diagnosis (D+1). Central lines are medians, boxes are interquartile ranges, and brackets are total range.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4219386&req=5

Figure 1: Serum concentrations of soluble triggering receptor expressed on myeloid cells (sTREM)-1. A. Daily log-transformed serum concentrations of sTREM-1 in the ventilator-associated pneumonia (VAP) group (white boxes) and in the non-VAP group (boxes with gray shading). B. Serum concentrations of sTREM-1 in the VAP group on the day before VAP diagnosis (D-1), on the day of VAP diagnosis (D0) and on the day after VAP diagnosis (D+1). Central lines are medians, boxes are interquartile ranges, and brackets are total range.

Mentions: There was no significant difference between groups in daily serum sTREM-1 concentrations and values did not change significantly over time in either group (p = 0.25). Peak serum sTREM-1 concentrations were observed on POD3 in patients with VAP (median 379 pg/ml; range 74–888 pg/ml) and POD2 in patients without VAP (median: 267 pg/ml; range: 75–411 pg/ml). In the group with VAP, comparison of serum concentrations of sTREM-1 on the day of VAP diagnosis (D0) with those on the day before (D-1) and on the day after (D+1) the diagnosis of VAP did not show a significant difference (p = 0.71) (Figure 1). Comparison of serum sTREM-1 concentrations on the day of VAP diagnosis with peak serum sTREM-1 concentrations in the non-VAP group also did not show a significant difference (p = 0.16). There was no correlation of serum sTREM-1 peak concentrations with duration of CPB (r = 0.08; p = 0.65) or duration of aortic cross-clamping time (r = -0.07; p = 0.72).


Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study.

Matsuno AK, Carlotti AP - BMC Cardiovasc Disord (2013)

Serum concentrations of soluble triggering receptor expressed on myeloid cells (sTREM)-1. A. Daily log-transformed serum concentrations of sTREM-1 in the ventilator-associated pneumonia (VAP) group (white boxes) and in the non-VAP group (boxes with gray shading). B. Serum concentrations of sTREM-1 in the VAP group on the day before VAP diagnosis (D-1), on the day of VAP diagnosis (D0) and on the day after VAP diagnosis (D+1). Central lines are medians, boxes are interquartile ranges, and brackets are total range.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4219386&req=5

Figure 1: Serum concentrations of soluble triggering receptor expressed on myeloid cells (sTREM)-1. A. Daily log-transformed serum concentrations of sTREM-1 in the ventilator-associated pneumonia (VAP) group (white boxes) and in the non-VAP group (boxes with gray shading). B. Serum concentrations of sTREM-1 in the VAP group on the day before VAP diagnosis (D-1), on the day of VAP diagnosis (D0) and on the day after VAP diagnosis (D+1). Central lines are medians, boxes are interquartile ranges, and brackets are total range.
Mentions: There was no significant difference between groups in daily serum sTREM-1 concentrations and values did not change significantly over time in either group (p = 0.25). Peak serum sTREM-1 concentrations were observed on POD3 in patients with VAP (median 379 pg/ml; range 74–888 pg/ml) and POD2 in patients without VAP (median: 267 pg/ml; range: 75–411 pg/ml). In the group with VAP, comparison of serum concentrations of sTREM-1 on the day of VAP diagnosis (D0) with those on the day before (D-1) and on the day after (D+1) the diagnosis of VAP did not show a significant difference (p = 0.71) (Figure 1). Comparison of serum sTREM-1 concentrations on the day of VAP diagnosis with peak serum sTREM-1 concentrations in the non-VAP group also did not show a significant difference (p = 0.16). There was no correlation of serum sTREM-1 peak concentrations with duration of CPB (r = 0.08; p = 0.65) or duration of aortic cross-clamping time (r = -0.07; p = 0.72).

Bottom Line: Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP.However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group.In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. apcarlotti@fmrp.usp.br.

ABSTRACT

Background: The diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery.

Methods: This was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1.

Results: Thirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).

Conclusion: Measurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

Show MeSH
Related in: MedlinePlus