Publication: sTREM-1 predicts mortality in hospitalized patients with infection in a tropical, middle-income country
Issued Date
2020-07-01
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ISSN
17417015
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2-s2.0-85087428910
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Mahidol University
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SCOPUS
Bibliographic Citation
BMC Medicine. Vol.18, No.1 (2020)
Suggested Citation
Shelton W. Wright, Lara Lovelace-Macon, Viriya Hantrakun, Kristina E. Rudd, Prapit Teparrukkul, Susanna Kosamo, W. Conrad Liles, Direk Limmathurotsakul, Direk Limmathurotsakul, T. Eoin West, T. Eoin West sTREM-1 predicts mortality in hospitalized patients with infection in a tropical, middle-income country. BMC Medicine. Vol.18, No.1 (2020). doi:10.1186/s12916-020-01627-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58098
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Title
sTREM-1 predicts mortality in hospitalized patients with infection in a tropical, middle-income country
Abstract
© 2020 The Author(s). Background: Few studies of biomarkers as predictors of outcome in infection have been performed in tropical, low- and middle-income countries where the burden of sepsis is highest. We evaluated whether selected biomarkers could predict 28-day mortality in infected patients in rural Thailand. Methods: Four thousand nine hundred eighty-nine adult patients admitted with suspected infection to a referral hospital in northeast Thailand were prospectively enrolled within 24 h of admission. In a secondary analysis of 760 patients, interleukin-8 (IL-8), soluble tumor necrosis factor receptor 1 (sTNFR-1), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and soluble triggering receptor expressed by myeloid cells 1 (sTREM-1) were measured in the plasma. Association with 28-day mortality was evaluated using regression; a parsimonious biomarker model was selected using the least absolute shrinkage and selection operator (LASSO) method. Discrimination of mortality was assessed by receiver operating characteristic curve analysis and verified by multiple methods. Results: IL-8, sTNFR-1, Ang-2, and sTREM-1 concentrations were strongly associated with death. LASSO identified a three-biomarker model of sTREM-1, Ang-2, and IL-8, but sTREM-1 alone provided comparable mortality discrimination (p = 0.07). sTREM-1 alone was comparable to a model of clinical variables (area under receiver operating characteristic curve [AUC] 0.81, 95% confidence interval [CI] 0.77-0.85 vs AUC 0.79, 95% CI 0.74-0.84; p = 0.43). The combination of sTREM-1 and clinical variables yielded greater mortality discrimination than clinical variables alone (AUC 0.83, 95% CI 0.79-0.87; p = 0.004). Conclusions: sTREM-1 predicts mortality from infection in a tropical, middle-income country comparably to a model derived from clinical variables and, when combined with clinical variables, can further augment mortality prediction. Trial registration: The Ubon-sepsis study was registered on ClinicalTrials.gov (NCT02217592), 2014.