The value of serum soluble trigger receptor expressed myeloid cell-1, procalcitonin and lactate in evaluating short-term prognosis of patients with severe pneumonia
FU Shunjin1, LIAO Qiming1, JIN Jianmin2.
1.Department of Emergency, Jinhua People’s Hospital, Jinhua 321000, China; 2.Blood Permeable Purification Center, Jinhua People’s Hospital, Jinhua 321000, China
FU Shunjin,LIAO Qiming,JIN Jianmin. The value of serum soluble trigger receptor expressed myeloid cell-1, procalcitonin and lactate in evaluating short-term prognosis of patients with severe pneumonia[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(9): 734-739.
Abstract：Objective: To explore the value of serum soluble trigger receptor expressed myeloid cell-1 (sTREM-1), procalcitonin (PCT) and lactate levels in evaluating the short-term prognosis of patients with severe pneumonia. Methods: A total of 198 patients with severe pneumonia confirmed in Jinhua People’s Hospital from October 2021 to December 2022 were included. According to the clinical outcome after 28 days of treatment,they were divided as the survival group (n=153) and the death group (n=45). The clinical data (gender, age,admission APACHE II and SOFA scores, proportion of septic shock) and blood biochemistry (admission time and 7 days after treatment) including sTREM-1, PCT, lactate, neutrophil to lymphocyte ratio (NLR), blood creatinine and urea nitrogen, C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), platelet to lymphocyte ratio (PLR) were compared. Multivariate Logistic regression was used to screen influencing factors,Spearman correlation analysis to analyze correlation, receiver operator characteristic curve (ROC) to calculate area under curve (AUC) and optimal critical value, Kaplan-Meier curve to plot cumulative survival rate. Results:The scores of APACHE II and SOFA, septic shock, sTREM-1, PCT, lactic acid, NLR, serum creatinine and urea nitrogen, CRP, IL-8 and TNF-α admission in the death group were significantly higher than in the survival group, while PLR was significantly decreased (P<0.05). Multivariate Logistic regression showed that the higher APACHE II score and increased sTREM-1, PCT and lactic acid were closely related to the 28-day death of severe pneumonia (P<0.05). Spearman correlation analysis showed that APACHE II score was significantly positively correlated with sTREM-1, PCT and lactate levels (r=0.620, 0.595 and 0.521, P<0.05). ROC showed AUC of sTREM-1, PCT and lactic acid for predicting death was 0.801, 0.698 and 0.745 respectively. AUC of sTREM-1 combined with lactic acid for predicting death was 0.899, with the cut-off value of sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L, respectively. A total of 198 patients were divided into high-risk group (n=59,sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L), medium-risk group (n=50, sTREM-1≥35.6 mmol/L or lactic acid≥1.68 mmol/L) and low-risk group (n=89, sTREM-1<35.6 mmol/L and lactic acid<1.68 mmol/L).The Kaplan-Meier survival curve showed that cumulative survival rate of high-risk group was the lowest (P<0.05). Conclusion: Early detection of sTREM-1, PCT and lactic acid for severe pneumonia is of great value in evaluating clinical outcome after 28-day treatment. sTREM-1 combined with lactic acid is the most valuable in predicting death, and sTREM-1≥35.6 mmol/L and lactic acid≥1.68 mmol/L are critical values.
