Zhao-liang WANG, Wen-ling ZHANG, Tao HUANG, Jia-quan GUO. Value of Dynamic Combined Monitoring of Serum Amyloid A Protein, Soluble Triggering Receptor Expressed on Myeloid Cell-1, and D-Dimer in Evaluating the Prognosis of Patients with Sepsis:A Prospective Nested Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 34-39. DOI: 10.3969/j.issn.1674-9081.20190051
Citation: Zhao-liang WANG, Wen-ling ZHANG, Tao HUANG, Jia-quan GUO. Value of Dynamic Combined Monitoring of Serum Amyloid A Protein, Soluble Triggering Receptor Expressed on Myeloid Cell-1, and D-Dimer in Evaluating the Prognosis of Patients with Sepsis:A Prospective Nested Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 34-39. DOI: 10.3969/j.issn.1674-9081.20190051

Value of Dynamic Combined Monitoring of Serum Amyloid A Protein, Soluble Triggering Receptor Expressed on Myeloid Cell-1, and D-Dimer in Evaluating the Prognosis of Patients with Sepsis:A Prospective Nested Case-control Study

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  • Corresponding author:

    ZHANG Wen-ling Tel: 86-731-82650348, E-mail: cszhangwenling@163.com

    HUANG Tao Tel: 86-898-68642560, E-mail:13005080993@163.com

  • Received Date: March 13, 2019
  • Issue Publish Date: January 29, 2020
  •   Objective  The aim of this study was to investigate the clinical significance of serum amyloid A protein (SAA), soluble triggering receptor expressed on myeloid cell-1(sTREM-1), and D-Dimer in the evaluation of prognosis of sepsis.
      Methods  From January 2018 to February 2019, patients with sepsis who were prospectively included in the ICU of Hainan Provincial People's Hospital were tested for the levels of SAA, sTREM-1, D-Dimer, C-reactive protein (CRP), and procalcitonin (PCT).Patients' acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were recorded. The patients who died within 28 days after the diagnosis of sepsis were included in the study group (death group), otherwise the septic patients were included in the control group (survival group). The multivariate Logistic regression analysis and the receiver operator characteristic (ROC) curve were used to analyze the correlation of each index with the prognosis of patients and the evaluation value.
      Results  A total of 82 patients with sepsis who met the inclusion and exclusion criteria were selected for this study, 51 males and 31 females, with an average age of (68.17±9.94) years. There were 30 cases in the death group and 52 cases in the survival group. There was no significant difference in age, sex, and body mass index between the two groups (all P>0.05). There were significant differences in APACHE Ⅱ scores, SAA, sTREM-1, D-Dimer, CRP, and PCT level between the survival group and the death group on the 1st, 3rd and 7th day after the diagnosis (all P < 0.05). Multivariate Logistic regression analysis showed that SAA (P=0.004), sTREM-1 (P=0.025), CRP (P=0.005), and PCT (P=0.016) were independent predictors for the prognosis of sepsis. It was also found that there was a positive correlation of SAA and sTREM-1 levels with APACHE Ⅱ scores on the 1st, 3rd and 7th day (all P < 0.05), and there was a positive correlation between D-Dimer and APACHE Ⅱ scores on the 3rd and 7th day (all P < 0.05). It was found that the areas under ROC curve of SAA on the 1st, 3rd and 7th day were the largest (0.878, 0.916, 0.954, respectively). On the 3rd and 7th day, the areas under the ROC curve of sTREM-1 were (0.907, 0.929) larger than those of CRP (0.897, 0.927) and PCT (0.892, 0.890). The areas under the ROC curve (0.918, 0.974, 0.984, respectively) of the combined detection of SAA, sTREM-1, and D-Dimer on the 1st, 3rd and 7th day were larger than those of the individual indexes.
      Conclusions  The dynamic joint monitoring results of SAA, sTREM-1, and D-Dimer can be used as the prognostic indicators for sepsis, and have a higher predictive value than traditional indicators such as CRP and PCT.
  • [1]
    Sinto R, Suwarto S, Widodo D. Comparison of Survival Prediction with Single versus Combination Use of Microcircula-tion End Point Resuscitation in Sepsis and Septic Shock[J]. Acta Med Indones, 2018, 50:275-282.
    [2]
    Zarjou A, Agarwal A. Sepsis and acute kidney injury[J]. J Am Soc Nephrol, 2011, 22:999-1006. DOI: 10.1681/ASN.2010050484
    [3]
    Reinhart K, Daniels R, Kissoon N, et al. Recognizing Sepsis as a Global Health Priority- A WHO Resolution[J]. N Engl J Med, 2017, 377:414-417. DOI: 10.1056/NEJMp1707170
    [4]
    Duggan S, Leonhardt I, Hunniger K, et al. Host response to Candida albicans bloodstream infection and sepsis[J]. Virulence, 2015, 6:316-326. https://www.ncbi.nlm.nih.gov/pubmed/25785541
    [5]
    陈兴旺, 赖剑波, 姚志军, 等.血和尿中可溶性髓样细胞触发受体-对脓毒症患者的早期诊断及预后评估价值[J].实用医学杂志, 2013, 29:3874-3877. http://www.cnki.com.cn/Article/CJFDTotal-SYYZ201323033.htm
    [6]
    Mithal LB, Palac HL, Yogev R, et al. Cord Blood Acute Phase Reactants Predict Early Onset Neonatal Sepsis in Preterm Infants[J].PLoS One, 2017, 12:e0168677. DOI: 10.1371/journal.pone.0168677
    [7]
    Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315:801-810. DOI: 10.1001/jama.2016.0287
    [8]
    Balakrishnan M, Gandhi H, Shah K, et al. Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery[J]. Indian J Anaesth, 2018, 62:934-939. http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=934;epage=939;aulast=Balakrishnan;type=0
    [9]
    Cornillon J, Bouteloup M, Lambert C. Evaluation of procalcitonin and CRP as sepsis markers in 74 consecutive patients admitted with prolonged febrile neutropenia[J]. J Infect, 2011, 63:93-95. DOI: 10.1016/j.jinf.2011.05.010
    [10]
    Su L, Feng L, Song Q, et al. Diagnostic value of dynamics serum sCD163, sTREM-1, PCT, and CRP in differentiating sepsis, severity assessment, and prognostic prediction[J]. Mediators Inflamm, 2013, 2013:969875. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713373/
    [11]
    Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, et al. Risk assessment in sepsis:a new prognostication rule by APACHE Ⅱ score and serum soluble urokinase plasminogen activator receptor[J]. Crit Care, 2012, 16:R149. DOI: 10.1186/cc11463
    [12]
    Townsend TR. Can serum amyloid A concentrations aid diagnosis of synovial sepsis?[J]. Vet Rec, 2017, 181:423-424. DOI: 10.1136/vr.j4751
    [13]
    Troia R, Gruarin M, Foglia A, et al. Serum amyloid A in the diagnosis of feline sepsis[J]. J Vet Diagn Invest, 2017, 29:856-859. DOI: 10.1177/1040638717722815
    [14]
    Jabor A, Holub Z, Franekova J, et al. Serum amyloid A as an effective marker for the assessment of surgical trauma and risk of post-operative complications[J]. Ceska Gynekol, 2006, 71:131-136.
    [15]
    Bouchon A, Facchetti F, Weigand MA, et al. TREM-1 amplifies inflammation and is a crucial mediator of septic shock[J]. Nature, 2001, 410:1103-1107. DOI: 10.1038/35074114
    [16]
    Patoulias D, Kalogirou MS, Patoulias I. Triggering Receptor Expressed on Myeloid Cells- (TREM-1) and its soluble in the plasma form (sTREM-1) as a diagnostic biomarker in neonatal sepsis[J]. Folia Med Cracov, 2018, 58:15-19. DOI: 10.1007/s11684-017-0505-z
    [17]
    Bouchon A, Dietrich J, Colonna M. Cutting edge:inflammatory responses can be triggered by TREM-1, a novel receptor expressed on neutrophils and monocytes[J]. J Immunol, 2000, 164:4991-4995. DOI: 10.4049/jimmunol.164.10.4991
    [18]
    Alkan OS, Ozer EA, Ilhan O, et al. Diagnostic value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for late-onset neonatal sepsis in infected preterm neonates[J]. J Int Med Res, 2018, 46:1606-1616. DOI: 10.1177/0300060517749131
    [19]
    Tripodi A. D-dimer testing in laboratory practice[J]. Clin Chem, 2011, 57:1256-1262. DOI: 10.1373/clinchem.2011.166249
    [20]
    Thachil J, Fitzmaurice DA, Toh CH. Appropriate use of D-dimer in hospital patients[J]. Am J Med, 2010, 123:17-19. DOI: 10.1016/j.amjmed.2009.09.011
    [21]
    Semeraro F, Ammollo CT, Caironi P, et al. Low D-dimer levels in sepsis:Good or bad?[J]. Thromb Res, 2018, 174:13-15.
    [22]
    Kountchev J, Bijuklic K, Bellmann R, et al. Reduction of D-dimer levels after therapeutic administration of antithrombin in acquired antithrombin deficiency of severe sepsis[J]. Crit Care, 2005, 9:R596-R600. DOI: 10.1186/cc3808
    [23]
    Su L, Li H, Xie A, et al. Dynamic changes in amino acid concentration profiles in patients with sepsis[J]. PLoS One, 2015, 10:e121933. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388841/
    [24]
    罗运山, 刘易林, 邓霞梅, 等. PCT、sTREM-1结合APACHE Ⅱ评分对脓毒症诊断和预后的价值[J].实用医学杂志, 2017, 33:586-590. http://www.cnki.com.cn/Article/CJFDTotal-SYYZ201704023.htm

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