sTREM-1 predicts mortality in hospitalized patients with infection in a tropical, middle-income country

• Published in: BMC medicine Vol. 18; no. 1; p. 159
• Main Authors: Wright, Shelton W, Lovelace-Macon, Lara, Hantrakun, Viriya, Rudd, Kristina E, Teparrukkul, Prapit, Kosamo, Susanna, Liles, W Conrad, Limmathurotsakul, Direk, West, T Eoin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-07-2020; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Angiopoietin; Biomarkers; Biomarkers - blood; Comorbidity; Confidence intervals; Cross Infection - diagnosis; Cytokines; Evaluation; Female; Hospital patients; Humans; Income; Infection; Infections; Interleukin 8; Interleukins; LMIC; Low- and middle-income countries; Male; Medical research; Middle Aged; Mortality; Myeloid cells; Patient outcomes; Patients; Plasma; Receptors; Regression analysis; Regression models; Secondary analysis; Sepsis; Soluble triggering receptor expressed by myeloid cells 1; Southeast Asia; Statistical analysis; sTREM-1; Thailand; Triggering Receptor Expressed on Myeloid Cells-1 - genetics; Tropical Climate; Tropical diseases; Tumor necrosis factor; Tumor necrosis factor receptor 1; Variables; Thailand; Southeast Asia; Soluble triggering receptor expressed by myeloid cells 1; LMIC; Sepsis; sTREM-1; Low- and middle-income countries
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-020-01627-5

Few studies of biomarkers as predictors of outcome in infection have been performed in tropical, low- and middle-income countries where the burden of sepsis is highest. We evaluated whether selected biomarkers could predict 28-day mortality in infected patients in rural Thailand.
Four thousand nine hundred eighty-nine adult patients admitted with suspected infection to a referral hospital in northeast Thailand were prospectively enrolled within 24 h of admission. In a secondary analysis of 760 patients, interleukin-8 (IL-8), soluble tumor necrosis factor receptor 1 (sTNFR-1), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and soluble triggering receptor expressed by myeloid cells 1 (sTREM-1) were measured in the plasma. Association with 28-day mortality was evaluated using regression; a parsimonious biomarker model was selected using the least absolute shrinkage and selection operator (LASSO) method. Discrimination of mortality was assessed by receiver operating characteristic curve analysis and verified by multiple methods.
IL-8, sTNFR-1, Ang-2, and sTREM-1 concentrations were strongly associated with death. LASSO identified a three-biomarker model of sTREM-1, Ang-2, and IL-8, but sTREM-1 alone provided comparable mortality discrimination (p = 0.07). sTREM-1 alone was comparable to a model of clinical variables (area under receiver operating characteristic curve [AUC] 0.81, 95% confidence interval [CI] 0.77-0.85 vs AUC 0.79, 95% CI 0.74-0.84; p = 0.43). The combination of sTREM-1 and clinical variables yielded greater mortality discrimination than clinical variables alone (AUC 0.83, 95% CI 0.79-0.87; p = 0.004).
sTREM-1 predicts mortality from infection in a tropical, middle-income country comparably to a model derived from clinical variables and, when combined with clinical variables, can further augment mortality prediction.
The Ubon-sepsis study was registered on ClinicalTrials.gov ( NCT02217592 ), 2014.