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

Receiver Operating Characteristic curve for soluble triggering receptor expressed on myeloid cells (sTREM)-1 levels in exhaled ventilator condensate on the day of ventilator-associated pneumonia diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Receiver Operating Characteristic curve for soluble triggering receptor expressed on myeloid cells (sTREM)-1 levels in exhaled ventilator condensate on the day of ventilator-associated pneumonia diagnosis.

Mentions: Peak sTREM-1 concentrations in EVC were observed in the VAP group on POD3 (median 11.5 pg/ml; range 0–163 pg/ml). In the non-VAP group, only two patients had detectable concentrations of sTREM-1 in EVC: one patient on POD4 (43 pg/ml) and POD5 (195 pg/ml) and the other on iPO (14 pg/ml), POD1 (17 pg/ml) and POD2 (49 pg/ml) (Figure 3). Both patients subsequently developed a surgical site infection. Twelve of 16 (75%) patients who developed VAP had sTREM-1 detected in EVC on the day of VAP diagnosis and/or the preceding day, while it was detectable in only 2 of 14 (14.3%) patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, 95% CI 0.48-0.93; specificity 0.86, 95% CI 0.57-0.98; positive predictive value 0.86, 95% CI 0.57-0.98; negative predictive value 0.75, 95% CI 0.48-0.93; positive likelihood ratio (LR) 5.25, 95% CI 3.99-6.9; negative LR 0.29, 95% CI 0.22-0.39). A cut-off value of 20.58 pg/ml of sTREM-1 in EVC on the day of VAP diagnosis had a sensitivity of 0.50 (95% CI 0.26-0.75) and a specificity of 0.86 (95% CI 0.56-0.98) for the diagnosis of VAP (area under the ROC curve 0.67; 95% CI 0.48-0.86) (Figure 4). Serum and mBAL sTREM-1 yielded areas under the ROC curve 0.60 and 0.42, respectively (data not shown).


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)

Receiver Operating Characteristic curve for soluble triggering receptor expressed on myeloid cells (sTREM)-1 levels in exhaled ventilator condensate on the day of ventilator-associated pneumonia diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Receiver Operating Characteristic curve for soluble triggering receptor expressed on myeloid cells (sTREM)-1 levels in exhaled ventilator condensate on the day of ventilator-associated pneumonia diagnosis.
Mentions: Peak sTREM-1 concentrations in EVC were observed in the VAP group on POD3 (median 11.5 pg/ml; range 0–163 pg/ml). In the non-VAP group, only two patients had detectable concentrations of sTREM-1 in EVC: one patient on POD4 (43 pg/ml) and POD5 (195 pg/ml) and the other on iPO (14 pg/ml), POD1 (17 pg/ml) and POD2 (49 pg/ml) (Figure 3). Both patients subsequently developed a surgical site infection. Twelve of 16 (75%) patients who developed VAP had sTREM-1 detected in EVC on the day of VAP diagnosis and/or the preceding day, while it was detectable in only 2 of 14 (14.3%) patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, 95% CI 0.48-0.93; specificity 0.86, 95% CI 0.57-0.98; positive predictive value 0.86, 95% CI 0.57-0.98; negative predictive value 0.75, 95% CI 0.48-0.93; positive likelihood ratio (LR) 5.25, 95% CI 3.99-6.9; negative LR 0.29, 95% CI 0.22-0.39). A cut-off value of 20.58 pg/ml of sTREM-1 in EVC on the day of VAP diagnosis had a sensitivity of 0.50 (95% CI 0.26-0.75) and a specificity of 0.86 (95% CI 0.56-0.98) for the diagnosis of VAP (area under the ROC curve 0.67; 95% CI 0.48-0.86) (Figure 4). Serum and mBAL sTREM-1 yielded areas under the ROC curve 0.60 and 0.42, respectively (data not shown).

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