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Expression of the triggering receptor expressed on myeloid cells-1 mRNA in a heterogeneous infected population
Abstract:
This study is to investigate the clinical utility of detection of peripheral blood triggering receptor expressed on myeloid cells (TREM)-1 mRNA as an early indicator of sepsis among critically ill patients and to compare the results of TREM-1 with those of C-reactive protein (CRP). A prospective, non-interventional study of 127 patients with at least two criteria of the systemic inflammatory response (SIRS) was performed. TREM-1 was assessed by real-time quantitative reverse transcription-polymerase chain reaction. The diagnosis of SIRS only was made in 41 patients (32%), and the diagnosis of sepsis was made in other 86 patients (68%). TREM-1 mRNA expression had the comparably discriminative value to differentiate the presence from the absence of infection, with an area under the receiver-operating characteristic curve (AUC) of 0.75 [95% confidence interval (95% CI), 0.67-0.84] than CRP [AUC, 0.72 (95% CI, 0.62-0.81)]. As an indicator of sepsis, a TREM-1 mRNA expression ratio cutoff value of 58.8 had a sensitivity of 72%, a specificity of 71%, a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.39. Furthermore, TREM-1 mRNA expression was selectively higher in septic patients caused by extracellular bacteria or fungi [112.4 (19.3-680.1)], than in those caused by intracellular bacteria or viruses [18.8 (7.6-53.0), p < 0.001]. There was no difference in plasma CRP levels between both septic groups (p = 0.782). TREM-1 and CRP are similar diagnostic markers of sepsis. The different ability of extracellular and intracellular pathogens to induce TREM-1 expression may provide a potential marker for differential diagnosis.
Insights
Detecting triggering receptor expressed on myeloid cells (TREM)-1 mRNA in blood shows similar diagnostic value to C-reactive protein (CRP) for early sepsis detection in critically ill patients. TREM-1 may help differentiate pathogen types.
Area of Science:
- Clinical Medicine
- Biomarkers
- Infectious Diseases
Background:
- Sepsis diagnosis in critically ill patients remains challenging.
- Early identification of sepsis is crucial for timely treatment and improved outcomes.
- Current biomarkers like C-reactive protein (CRP) have limitations in specificity and differentiating infection sources.
Purpose of the Study:
- To evaluate the clinical utility of peripheral blood triggering receptor expressed on myeloid cells (TREM)-1 mRNA as an early sepsis indicator.
- To compare the diagnostic performance of TREM-1 mRNA with CRP in critically ill patients.
- To explore TREM-1's potential in differentiating sepsis caused by different pathogen types.
Main Methods:
- Prospective, non-interventional study of 127 critically ill patients meeting Systemic Inflammatory Response Syndrome (SIRS) criteria.
- TREM-1 mRNA levels assessed using real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR).
- Comparison of TREM-1 mRNA and CRP diagnostic values using receiver-operating characteristic (ROC) curve analysis.
Main Results:
- Sepsis diagnosis was confirmed in 86 patients (68%).
- TREM-1 mRNA demonstrated comparable discriminative value to CRP for infection detection (AUC 0.75 vs. 0.72).
- TREM-1 mRNA expression was significantly higher in sepsis caused by extracellular bacteria/fungi compared to intracellular bacteria/viruses (p < 0.001), unlike CRP.
Conclusions:
- TREM-1 mRNA and CRP are similar diagnostic markers for sepsis in critically ill patients.
- TREM-1 mRNA exhibits potential as a biomarker to differentiate sepsis caused by extracellular versus intracellular pathogens.
- Further research into TREM-1's role in differential diagnosis of sepsis is warranted.
