0
Summaries for Patients |

A Possible New Test for Diagnosing Sepsis FREE

[+] Article and Author Information

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.


Ann Intern Med. 2004;141(1):I-46. doi:10.7326/0003-4819-141-1-200407060-00002
Text Size: A A A

What is the problem and what is known about it so far?

Bacterial infection of the blood can result in a condition called sepsis, the most common cause of death in intensive care units. This type of infection can lead the body to make chemicals that cause a severe form of inflammation, called the systemic inflammatory response syndrome (SIRS). This syndrome occurs in patients with sepsis and in sick people who do not have sepsis. Telling the difference between SIRS with sepsis and SIRS with no sepsis is important because patients with sepsis need immediate treatment with antibiotics. It can be very difficult to know if a patient with SIRS also has sepsis, so a test for sepsis would be helpful. Doctors do test for bacteria in the blood, but this test can take many hours to become positive. The ideal test would give an answer right away, so that doctors could decide whether to use antibiotics and be fairly sure they made the right decision. Doctors usually start antibiotics immediately when they suspect sepsis, so many patients who don't have sepsis get antibiotics for several days until results of blood tests for bacteria are negative. Exposure to antibiotics can be harmful.

One possibility is to detect a protein made by inflammatory cells that kill bacteria. When bacteria are present, inflammatory cells rapidly start making a protein that causes inflammation. This protein, called triggering receptor expressed on myeloid cells-1 (TREM-1), is present on the surface of the inflammatory cells. As these cells circulate in the blood, some of the TREM-1 gets into the blood. Blood levels of TREM-1 are high during bacterial infection and low in other causes of SIRS.

Why did the researchers do this particular study?

To determine whether the blood level of TREM-1 was a good test for sepsis in patients with SIRS.

Who was studied?

76 patients who were admitted to intensive care units because their doctors thought they might have infections of the blood.

What did the researchers do?

The researchers took a careful history, performed tests to measure the severity of illness, and drew blood to test for TREM-1 and for bacteria in the blood. Two expert physicians reviewed all of the information (except blood TREM-1 levels) and diagnosed SIRS (without bacterial infection of the blood) in 29 patients, bacterial infection of the blood in 22 patients, and bacterial blood infection with shock (the most severe form of bacterial blood infection) in 25 patients.

What did the researchers find?

A blood TREM-1 level above a certain value was a very good test for bacterial infection of the blood. It detected almost all the patients with sepsis (96%). Only 11% of patients with SIRS but not sepsis had increased TREM-1 levels. This means that a doctor would be correct 97% of the time if she said that a patient with an increased TREM-1 level had sepsis.

What were the limitations of the study?

Since the patients were all quite sick, it is not possible to say how the test would work in less ill patients. The authors also did not study patients older than 80 years of age or patients who had weak immunity.

What are the implications of the study?

The test for TREM-1 may help doctors to correctly diagnose sepsis much more quickly, which means that they can avoid giving antibiotics to people who don't have sepsis.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)