Diagnostic value of urine sTREM-1 for sepsis and relevant acute kidney injuries: a prospective study.

INTRODUCTION: We explored the diagnostic value of a urine soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for early sepsis identification, severity and prognosis assessment, and for secondary acute kidney injury (AKI). We compared this with white blood cell (WBC) counts, serum C-reactive protein (CRP), serum procalcitonin (PCT), urine output, creatinine clearance (CCr), serum creatinine (SCr), and blood urea nitrogen (BUN). METHODS: We enrolled 104 subjects admitted to the ICU: 16 cases with systemic inflammatory response syndrome (SIRS); 35 with sepsis and 53 with severe sepsis. Results for urine sTREM-1, WBC, serum CRP and serum PCT were recorded on days 1, 3, 5, 7, 10, and 14. For 17 sepsis cases diagnosed with secondary AKI, comparisons between their urine sTREM-1, urine output, CCr, SCr and BUN at diagnosis and 48 h before diagnosis were made. RESULTS: On the day of admission to the ICU, and compared with the SIRS group, the sepsis group exhibited higher levels of urine sTREM-1 and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores (P < 0.05). Areas under the curve (AUC) shaped by the scores were 0.797 (95% CI 0.711 to 0.884) and 0.722 (95% CI 0.586 to 0.858), respectively. On days 1, 3, 5, 7, 10, and 14, urine sTREM-1, serum PCT and WBC levels registered higher in the severe sepsis group in contrast to the sepsis group (P < 0.05). Urine sTREM-1 and serum PCT levels continuously increased among non-survivors, while WBC and serum CRP levels in both groups declined. For 17 patients with AKI, urine sTREM-1, SCr and BUN levels at 48 h before AKI diagnosis were higher, and CCr level was lower than those for non-AKI subjects (P < 0.05). AUC for urine sTREM-1 was 0.922 (95% CI 0.850 to 0.995), the sensitivity was 0.941, and the specificity was 0.76 (based on a cut-off point of 69.04 pg/ml). Logistic regression analysis showed that urine sTREM-1 and severity were risk factors related to AKI occurrence. CONCLUSIONS: Besides being non-invasive, urine sTREM-1 testing is more sensitive than testing WBC, serum CRP, and serum PCT for the early diagnosis of sepsis, as well as for dynamic assessments of severity and prognosis. It can also provide an early warning of possible secondary AKI in sepsis patients. TRIAL REGISTRATION: ClinicalTrial.gov identifier NCT01333657.

[Clinical analysis of value of different modes of respiratory support in the treatment of critical patients].

OBJECTIVE: To investigate the relationship between the successful results with different methods and time of initiation of respiratory support in critically ill patients. METHODS: The clinical data of 458 critical care patients were reviewed and analyzed. Among the patients, there were 47 cases of cardio-pulmonary resuscitation, 105 cases of acute airway obstruction, 156 cases of acute respiratory failure, and 150 cases of chronic respiratory failure. Intubation, or tracheostomy, or non-invasive positive pressure ventilation (NPPV) at different times and occasions were performed in the patients. RESULTS: One hundred and seventeen cases (25.5%) died during the respiratory support treatment, 49 cases gave up the treatment, and 292 patients (63.8%) were cured after mechanical ventilation. As the success rate was the lowest in patients who survived cardio-pulmonary resuscitation (21.3%, 10/47), it was higher in acute respiratory failure (55.1%, 86/156), and the best result (82.8%, 87/105) was obtained in the acute airway obstruction group and patients with chronic respiratory failure (72.7%, 109/150). In the group of patients undergoing early respiratory support, the cure rate was 95.0% (57/60) in patients with invasive method, and 95.5% (21/22) in the NPPV group. The result was significantly different compared with that of later treatment group [81.7% (68/82) in invasive group, and 60.9% (2/29) in NPPV group, both P<0.01]. It demonstrated that the earlier the respiratory support was given the better results. If the respiratory support was delayed, cure rate was significantly reduced [65.6% (63/96) in invasive group and 48.1% (13/27) in NPPV group, both P<0.01]. The cure rate was no difference between different modes of respiratory support between early treatment groups, however, invasive respiratory support was much better than NPPV [44.4% (40/90) and 0 (0/5)] when instituted in the late stages (all P<0.01). CONCLUSION: It is of prime importance to ensure optimal ventilation in the early stage of diseases, the difficulty and risk of establishment of a patent airway are main problems in the treatment of critically ill patients.