Log in | Register

Soluble triggering receptor expressed on myeloid cells in severe acute pancreatitis: a biological marker of infected necrosis

Zheng Lu| Yan Liu| Yuan-hang Dong| Xian-bao Zhan| Yi-qi Du| Jun Gao| Yan-fang Gong| Zhao-shen Li
Original
Volume 38, Issue 1 / January , 2012

Pages 69 - 75

Abstract

Purpose

The diagnosis and treatment of secondary infection of pancreatic necrotic tissue remain a major challenge. The level of soluble triggering receptor expressed on myeloid cells (sTREM-1) in fine needle aspiration (FNA) fluid may be a good marker of infected necrosis.

Methods

Patients with a clinical suspicion of secondary infection of necrotic tissue were enrolled. The serum levels of C-reactive protein, amylase, procalcitonin (PCT), and sTREM-1 and the fluid levels of sTREM-1, PCT, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and amylase were examined. When infected necrosis was defined, the first step was percutaneous or endoscopic drainage. If there was no improvement after 72 h, an open necrosectomy was performed.

Results

In 30 patients with suspected infection, 18 patients were diagnosed as having secondary infection of necrotic tissue. The levels of sTREM-1 and PCT in FNA fluid were found to have the closest correlation with the diagnosis of infected necrosis [sTREM-1: area under the receiver operating characteristic curve (AUC) 0.972; 95% confidence interval (95%CI) 0.837–1.000; PCT: AUC 0.903; 95%CI 0.670–0.990, P > 0.05]. A fluid sTREM-1 cutoff value of 285.6 pg/ml had a sensitivity of 94.4% and a specificity of 91.7%. In a multiple logistic regression analysis, an sTREM-1 level of more than 285 pg/ml and a PCT level of more than 2.0 ng/ml in FNA fluid were independent predictors of infected necrosis.

Conclusions

The fluid level of sTREM-1 will help in the rapid and accurate diagnosis of secondary infection of necrotic tissue in patients with severe acute pancreatitis (SAP).

Keywords

References

  1. Whitcomb DC (2006) Acute pancreatitis. N Engl J Med 354:2142–2150
    • View reference on PubMed
    • View reference on publisher's website
  2. Isenmann R, Buchler MW (1994) Infection and acute pancreatitis. Br J Surg 81:1707–1708
    • View reference on PubMed
    • View reference on publisher's website
  3. Rau B, Pralle U, Mayer JM, Beger HG (1998) Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis. Br J Surg 85:179–184
    • View reference on PubMed
    • View reference on publisher's website
  4. Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I (1999) Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 25:195–210
    • View reference on PubMed
  5. Yousaf M, McCallion K, Diamond T (2003) Management of severe acute pancreatitis. Br J Surg 90:407–420
    • View reference on PubMed
    • View reference on publisher's website
  6. Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford J, Freeny P, Imrie C, Tandon R, Working Party of the Program Committee of the Bangkok World Congress of Gastroenterology 2002 (2002) Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 17(Suppl):S15–S39
    • View reference on PubMed
    • View reference on publisher's website
  7. Riché FC, Cholley BP, Laisné MJ, Vicaut E, Panis YH, Lajeunie EJ, Boudiaf M, Valleur PD (2003) Inflammatory cytokines, C reactive protein, and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis. Surgery 133:257–262
    • View reference on PubMed
    • View reference on publisher's website
  8. Mettu SR, Wig JD, Khullar M, Singh G, Gupta R (2003) Efficacy of serum nitric oxide level estimation in assessing the severity of necrotizing pancreatitis. Pancreatology 3:506–513
    • View reference on PubMed
    • View reference on publisher's website
  9. Halonen KI, Leppäniemi AK, Lundin JE, Puolakkainen PA, Kemppainen EA, Haapiainen RK (2003) Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology 3:309–315
    • View reference on PubMed
    • View reference on publisher's website
  10. Dambrauskas Z, Pundzius J, Barauskas G (2006) Predicting development of infected necrosis in acute necrotizing pancreatitis. Medicina (Kaunas) 42:441–449
  11. Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE (2004) Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 350:451–458
    • View reference on PubMed
    • View reference on publisher's website
  12. Besselink MG, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, Buskens E, Dejong CH, van Eijck CH, van Goor H, Hofker SS, Lameris JS, van Leeuwen MS, Ploeg RJ, van Ramshorst B, Schaapherder AF, Cuesta MA, Consten EC, Gouma DJ, van der Harst E, Hesselink EJ, Houdijk LP, Karsten TM, van Laarhoven CJ, Pierie JP, Rosman C, Bilgen EJ, Timmer R, van der Tweel I, de Wit RJ, Witteman BJ, Gooszen HG, Dutch Acute Pancreatitis Study Group (2006) Minimally invasive ‘step-up approach’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial. BMC Surg 6:6
    • View reference on PubMed
    • View reference on publisher's website
  13. Heath DI, Cruickshank A, Gudgeon M, Jehanli A, Shenkin A, Imrie CW (1993) Role of interleukin-6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis. Gut 34:41–45
    • View reference on PubMed
    • View reference on publisher's website
  14. Viedma JA, Pérez-Mateo M, Domínguez JE, Carballo F (1992) Role of interleukin-6 in acute pancreatitis comparison with C-reactive protein and phospholipase A. Gut 33:1264–1267
    • View reference on PubMed
    • View reference on publisher's website
  15. Rau B, Steinbach G, Gansauge F, Mayer JM, Grünert A, Beger HG (1997) The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 41:832–840
    • View reference on PubMed
    • View reference on publisher's website
  16. Oláh A, Belágyi T, Issekutz A, Makay R, Zaborszky A (2005) Value of procalcitonin quick test in the differentiation between sterile and infected forms of acute pancreatitis. Hepatogastroenterology 52:243–245
    • View reference on PubMed
  17. Bouchon A, Facchetti F, Weigand MA, Colonna M (2001) TREM-1 amplifies inflammation and is a crucial mediator of septic shock. Nature 410:1103–1107
    • View reference on PubMed
    • View reference on publisher's website
  18. Lin CH, Yao M, Hsu SC, Ho CC, Lin MT, Lin CA, Hu FC, Yu CJ, Tien HF (2011) Soluble triggering receptor expressed on myeloid cells-1 as an infection marker for patients with neutropenic fever. Crit Care Med 32:167–174
  19. Determann RM, van Till JW, van Ruler O, van Veen SQ, Schultz MJ, Boermeester MA (2009) sTREM-1 is a potential useful biomarker for exclusion of ongoing infection in patients with secondary peritonitis. Cytokine 46:36–42
    • View reference on PubMed
    • View reference on publisher's website
  20. Kamei K, Yasuda T, Ueda T, Qiang F, Takeyama Y, Shiozaki H (2010) Role of triggering receptor expressed on myeloid cells-1 in experimental severe acute pancreatitis. J Hepatobiliary Pancreat Sci 17:305–312
    • View reference on PubMed
    • View reference on publisher's website
  21. Yasuda T, Takeyama Y, Ueda T, Shinzeki M, Sawa H, Takahiro N, Kamei K, Ku Y, Kuroda Y, Ohyanagi H (2008) Increased levels of soluble triggering receptor expressed on myeloid cells-1 in patients with acute pancreatitis. Crit Care Med 36:2048–2053
    • View reference on PubMed
    • View reference on publisher's website
  22. Howard TJ, Patel JB, Zyromski N, Sandrasegaran K, Yu J, Nakeeb A, Pitt HA, Lillemoe KD (2007) Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg 11:43–49
    • View reference on PubMed
    • View reference on publisher's website
  23. Mortelé KJ, Girshman J, Szejnfeld D, Ashley SW, Erturk SM, Banks PA, Silverman SG (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170:969–975
  24. Baril NB, Ralls PW, Wren SM, Selby RR, Radin R, Parekh D, Jabbour N, Stain SC (2000) Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg 231:361–367
    • View reference on PubMed
    • View reference on publisher's website
  25. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG, Group DutchPancreatitisStudy (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502
    • View reference on PubMed
    • View reference on publisher's website
  26. Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245:943–951
    • View reference on PubMed
    • View reference on publisher's website
  27. Wyncoll DL (1999) The management of severe acute necrotizing pancreatitis: an evidence-based review of the literature. Intensive Care Med 25:146–156
  28. van Santvoort HC, Besselink MG, Horvath KD, Sinanan MN, Bollen TL, van Ramshorst B, Gooszen HG, Dutch Acute Pancreatis Study Group (2007) Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB (Oxford) 9:156–159
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement