Can sTREM-1 predict septic shock & death in late-onset neonatal sepsis? A pilot study

• In our sample of LONS, sTREM-1 had a median of 10 pg/mL (IQR = 10 to 95 pg/mL).
• In LONS that progressed to shock/death, sTREM-1 had a median of 567 (IQR = 260 to 649) pg/mL.
• In our population of LONS, sTREM-1 >300 pg/mL correctly predicted progression to septic shock, with a sensitivity of 0.78 (95%CI = 0.46 to 0.94) and a specificity of 0.97 (95% CI = 0.92 to 0.99).

SummaryBackground and ObjectivesThe transmembrane glycoprotein TREM-1 triggers an inflammatory response. Its soluble fraction (sTREM-1) has been shown to have diagnostic accuracy for late-onset neonatal sepsis (LONS). Until now, the potential of sTREM-1 to predict septic shock and/or death in septic neonates has not been explored. This study obtained estimates of the incidence and prevalence of septic shock and/or death in septic neonates for future sample size calculations for confirmatory studies and evaluated the feasibility of using sTREM-1 as a predictor of septic shock and/or death in neonates with LONS criteria.Study designA pilot study with a cross-sectional design was performed from May 1st to October 31st, 2012. The participants were hospitalized neonates who, after three days of life, were diagnosed as having LONS. Plasma sTREM-1 was quantified by ELISA. The main outcome measurement was the development of septic shock and/or death.ResultsOf 71 eligible subjects, nine (12.7%) progressed to septic shock and/or death. In the LONS-Non-Shock group, the sTREM-1 median and interquartile range (IQR) plasma value were 10 (10 to 70) pg/mL. In the LONS & Shock/Death group, the values were 567 (260 to 649) pg/mL. These values were significantly different (Mann-Whitney’s U test, p = 0.001).A ROC curve for a proposed sTREM-1 cut-off value of 300 pg/mL exhibited an area under the curve of 0.884 (95% CI = 0.73 to 1.0; p < 0.0001), with a sensitivity of 0.78 (95% CI = 0.46 to 0.94) and specificity of 0.97 (95% CI = 0.92 to 0.99); PPV would be 0.78 (95% CI = 0.46 to 0.94) and NPV 0.97 (95% CI = 0.92 to 0.99).ConclusionsIn neonates with LONS, sTREM-1 has the potential to provide an excellent predictive value for septic shock/death. Larger sample sizes are needed to identify the optimal cut-off value of plasma sTREM-1 for this diagnosis and to provide diagnostic accuracy measures.