TREM-1: A potential prognostic marker in newborns with late-onset sepsis

Diagnosing late-onset neonatal sepsis (LOS) continues to be a complex task, highlighting the need for continued research to discover reliable biomarkers that can improve both diagnostic accuracy and prognostic evaluation. This experimental prospective cohort study aimed to assess the potential of TREM-1 as a diagnostic and prognostic marker for LOS.

This study included 121 newborns (NBs) distributed as follows: 84 blood samples from NBs with LOS, categorized into Gram-negative sepsis, Gram-positive sepsis, and culture-negative sepsis groups, along with 37 infection-free controls. sTREM-1 levels were measured using an immunoenzymatic assay on samples collected at diagnosis and on days 3 and 7 afterward, while TREM1 gene expression was assessed by RT-qPCR on the day of diagnosis.

Despite not being a significant diagnostic tool, the univariate logistic regression indicated that high sTREM-1 levels were strongly associated with septic shock, in addition to thermal instability and male sex. The adjusted multivariate analysis confirmed that elevated sTREM-1 levels (OR = 3.85, p = 0.032), and male sex (OR = 5.67, p = 0.016) were significantly associated with septic shock. Gene expression analysis revealed reduced TREM1 gene expression in infected neonates relative to controls; however, patients who died showed significantly higher expression levels (p < 0.001), indicating its potential as a prognostic marker in neonatal sepsis.

sTREM-1 showed good accuracy as a predictor of severity in LOS. TREM1 high expression was associated with a worse prognosis in septic neonates. However, additional studies involving a larger number of individuals are necessary to validate the clinical utility of this biomarker in practice.