sTREM-1 and LBP in central venous catheter-associated bloodstream infections in pediatric intestinal failure.

ABSTRACT

OBJECTIVE: Central venous catheter-associated bloodstream infections (CVC-BSIs) are a major cause of morbidity and mortality in the pediatric intestinal failure (IF) population. We assessed plasma lipopolysaccharide-binding protein (LBP) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as biomarkers for CVC-BSI. We hypothesized that sTREM-1 and LBP rise with BSI and decline following treatment, and that baseline LBP is higher in the IF population than in controls. PATIENTS AND METHODS: Patients younger than 4 years were recruited from the IF registry at Cincinnati Children's Hospital. LBP and sTREM-1 levels were measured on 22 patients with IF at baseline, 17 patients with IF with BSIs, and 11 healthy controls. RESULTS: Mean sTREM-1 level (pg/mL) and LBP level (µg/mL) rose with CVC-BSI over baseline (115.0 ±â€Š51.2 vs 85.9 ±â€Š27.6, P = 0.011 and 79.8 ±â€Š45.4 vs 20.5 ±â€Š11.3, P < 0.001, respectively) and declined following antibiotic therapy (115.0 ±â€Š51.2 vs 77.9 ±â€Š29.8, P = 0.003 and 79.8 ±â€Š45.4 vs 26.2 ±â€Š10.8, P < 0.001, respectively). Receiver operating characteristic curves showed that neither sTREM-1 nor LBP is sufficient to predict bacteremia versus fever without bacteremia (area under these curves = 0.57 and 0.82, respectively). Baseline LBP was higher in hospitalized patients than in outpatients (27.5 ±â€Š8.7 vs 13.5 ±â€Š9.2, P = 0.002), patients with previous BSIs versus those without (23.5 ±â€Š10.4 vs 10.1 ±â€Š8.3, P = 0.016), and those listed for transplantation versus those not listed (29.6 ±â€Š9.8 vs 16.2 ±â€Š9.5, P = 0.033). CONCLUSIONS: sTREM-1 and LBP rise with CVC-BSI in IF and decline after treatment; however, neither distinguishes infection from nonbacteremic febrile episodes. Baseline LBP may be a marker of disease severity in IF.