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Plasma Level of a Triggering Receptor Expressed on Myeloid Cells-1: Its Diagnostic Accuracy in Patients with Suspected Sepsis

Sébastien Gibot, MD; Marie-Nathalie Kolopp-Sarda, PharmD, PhD; Marie C. Béné, PharmSci, PhD; Aurélie Cravoisy, MD; Bruno Levy, MD, PhD; Gilbert C. Faure, MD, PhD; and Pierre-Edouard Bollaert, MD, PhD
[+] Article and Author Information

From Hôpital Central, Nancy, and Faculté de Médecine, Vandoeuvre-les-Nancy, France.


Acknowledgments: The authors thank Dr. Marco Colonna for providing anti–TREM-1 antibody and the nursing staff of the intensive care unit for their compliance with the study protocol.

Grant Support: By the Programme Hospitalier de Recherche Clinique, 2000–2003, and by the French Ministère de la Recherche et de la Technologie (grant EA3443).

Potential Financial Conflicts of Interest:Grants received: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, G.C. Faure (Programme Hospitalier de Recherche Clinique, French Ministère de la Recherche et de la Technologie).

Requests for Single Reprints: Sébastien Gibot, MD, Hôpital Central, Service de Réanimation Médicale, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.

Current Author Addresses: Drs. Gibot, Cravoisy, Lévy, and Bollaert: Hôpital Central, Service de Réanimation Médicale, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.

Drs. Kolopp-Sarda, Béné, and Faure: Laboratoire d'Immunologie, Faculté de Médecine, Avenue du Foret de Haye, 54500 Vandoeuvre-les-Nancy, France.

Author Contributions: Conception and design: S. Gibot, M.-N. Kolopp-Sarda, B. Levy, P.-E. Bollaert.

Analysis and interpretation of the data: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, A. Cravoisy, B. Levy, P.-E. Bollaert.

Drafting of the article: S. Gibot, M.C. Béné, P.-E. Bollaert.

Critical revision of the article for important intellectual content: M.C. Béné, A. Cravoisy, B. Levy, G.C. Faure, P.-E. Bollaert.

Final approval of the article: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, A. Cravoisy, B. Levy, G.C. Faure, P.-E. Bollaert.

Provision of study materials or patients: S. Gibot, A. Cravoisy, B. Levy.

Statistical expertise: S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, B. Levy, G.C. Faure.

Obtaining of funding: M.-N. Kolopp-Sarda, M.C. Béné, G.C. Faure.

Administrative, technical, or logistic support: M.-N. Kolopp-Sarda, A. Cravoisy, G.C. Faure.

Collection and assembly of data: S. Gibot, B. Levy.


Ann Intern Med. 2004;141(1):9-15. doi:10.7326/0003-4819-141-1-200407060-00009
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Our data clearly suggest that assaying the soluble form of TREM-1 in plasma samples from newly admitted critically ill patients with suspected sepsis may be a valuable new approach to accurately diagnosing infectious processes. Early identification of infection has a major effect on the clinical course, management, and outcome of critically ill patients. Critical care physicians have a variety of indicators to help them discriminate infectious from noninfectious conditions in newly admitted patients. In some cases, the diagnosis of sepsis becomes clear after the medical history and physical examination are completed (20). In other circumstances, when noninfectious insults (for example, trauma, hemorrhage, burns, and pancreatitis) cause the systemic inflammatory response syndrome, diagnosis of sepsis remains challenging. Efforts have therefore been made to identify a reliable marker of infection. However, to date, no single clinical or biological indicator of sepsis has gained widespread acceptance (7, 21). Among the potentially useful markers, procalcitonin has been proposed as the most promising (68), but several authors have challenged this (911).

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Figures

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Figure 1.
Flow chart of the patients admitted to the intensive care unit (ICU) during the study period.

SIRS = systemic inflammatory response syndrome.

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Figure 2.
Plasma levels at admission of C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells-1 (TREM-1), according to diagnosis.

Individual values are plotted; bars represent the medians of the values.  < 0.001 for comparisons between the systemic inflammatory response syndrome (SIRS) and sepsis and between SIRS and septic shock. Twenty-nine patients had SIRS of noninfectious origin, 22 patients had sepsis or severe sepsis, and 25 patients had septic shock.

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Figure 3.
Receiver-operating characteristic curves for various cutoff plasma levels of C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells-1 (TREM-1) in differentiating between presence and absence of infection.

Areas under the receiver-operating characteristic curves were 0.77 (95% CI, 0.69 to 0.85) for C-reactive protein, 0.85 (CI, 0.81 to 0.89) for procalcitonin, and 0.97 (CI, 0.94 to 1.0) for soluble TREM-1.

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Appendix Figure.
Plasma levels of C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells-1 (TREM-1) at admission in patients with sepsis, severe sepsis, and septic shock according to outcome.

Individual values are plotted; bars represent the medians of the values. In comparisons between survivors and nonsurvivors,  > 0.2 for C-reactive protein and procalcitonin and  = 0.05 for soluble TREM-1.

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Summary for Patients

A Possible New Test for Diagnosing Sepsis

The summary below is from the full report titled “Plasma Level of a Triggering Receptor Expressed on Myeloid Cells-1: Its Diagnostic Accuracy in Patients with Suspected Sepsis.” It is in the 6 July 2004 issue of Annals of Internal Medicine (volume 141, pages 9-15). The authors are S. Gibot, M.-N. Kolopp-Sarda, M.C. Béné, A. Cravoisy, B. Levy, G.C. Faure, and P.-E. Bollaert.

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