Soluble triggering receptor expressed on myeloid cells-1 as an infection marker for patients with neutropenic fever
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Chou-Han Lin1, Ming Yao, Szu-Chun Hsu
1Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Objective:
To assess the value of soluble triggering receptor expressed on myeloid cells-1 as a biomarker of infection in patients with neutropenic fever comparing with procalcitonin and C-reactive protein.
Design:
Prospective, comparative, single-center study.
Setting:
Hematology ward at a university hospital.
Subjects:
Seventy-five patients with neutropenic fever after chemotherapy for their hematologic malignancies.
Intervention:
None.
Measurements And Main Results:
A total of 137 episodes of neutropenic fever in 75 patients were classified into 75 episodes of documented infections and 62 low likelihood of infection. The level of soluble triggering receptor expressed on myeloid cells-1 was significantly elevated in the group of documented infection. The area under the receiver operating characteristic curve for the diagnosis of infection was 0.719 (95% confidence interval, 0.632-0.806; p < .0001) for soluble triggering receptor expressed on myeloid cells-1, which was larger than the values of 0.501 for procalcitonin (0.465-0.657; p = .218) and 0.491 for C-reactive protein (0.394-0.589, p = .858). The fitted marginal logistic regression model of all episodes contained two statistically significant predictors of infection: soluble triggering receptor expressed on myeloid cells-1 (per 1-pg/mL increase; odds ratio [OR], 1.0002; 95% CI, 1.0001-1.0003; p < .0001) and procalcitonin (per 1-ng/mL increase; OR, 1.0094; 95% CI, 1.0005-1.0184; p = .0002). In a diagnostic panel with soluble triggering receptor expressed on myeloid cells-1 and procalcitonin, the sensitivity and specificity were 88% and 48%, respectively.
Conclusions:
Soluble triggering receptor expressed on myeloid cells-1 is better than procalcitonin in the prediction of infection at the onset of neutropenic fever. By applying soluble triggering receptor expressed on myeloid cells-1 and procalcitonin together, low or high risk for infection can be defined at the onset of neutropenic fever.
Insights
Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) shows promise as a biomarker for infection in neutropenic fever patients. Combining sTREM-1 with procalcitonin helps define infection risk at fever onset.
Area of Science:
- Biomarkers
- Infectious Diseases
- Hematology
Background:
- Neutropenic fever is a common complication in patients with hematologic malignancies undergoing chemotherapy.
- Early and accurate diagnosis of infection is crucial for timely treatment and improved outcomes.
Purpose of the Study:
- To evaluate soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic biomarker for infection in neutropenic fever.
- To compare the diagnostic performance of sTREM-1 with procalcitonin (PCT) and C-reactive protein (CRP).
Main Methods:
- Prospective, comparative study involving 75 patients with neutropenic fever.
- Measured sTREM-1, PCT, and CRP levels.
- Analyzed diagnostic accuracy using receiver operating characteristic (ROC) curves and logistic regression.
Main Results:
- sTREM-1 levels were significantly elevated in patients with documented infections (AUC=0.719).
- sTREM-1 demonstrated superior diagnostic performance compared to PCT (AUC=0.501) and CRP (AUC=0.491).
- Both sTREM-1 and PCT were significant predictors of infection in logistic regression models.
Conclusions:
- sTREM-1 is a more effective predictor of infection than PCT in neutropenic fever.
- A combination of sTREM-1 and PCT can help stratify patients into low or high risk for infection at fever onset.
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