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Urinary soluble triggering receptor expressed on myeloid cells-1 is an early predictor for sepsis outcome and sepsis-induced acute kidney injury

Background Recent reports had indicated the usefulness of urinary soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a prognostic marker for sepsis and sepsis-induced acute kidney injury (AKI). Objective This study aimed to detect the prognostic value of urinary sTREM-1 in sepsis in terms of the clinical course, development of AKI, and the survival rate. Patients and methods Thirty critically ill patients with sepsis were included (57.6±7.5 years, 18 men), in addition to a group of 10 controls (45.6±3.5 years, six men). Urinary sTREM-1 and C-reactive protein serum levels were estimated on admission, and days 3 and 7. The sepsis-related organ failure assessment scoring system was calculated at baseline and daily until discharge, mortality, or up to 28 days. Length of stay in ICU, need for vasopressors, mechanical ventilation or hemodialysis, and development of AKI and the outcomes were recorded. Results Compared with stable patients, patients who required vasopressors (23 patients) or hemodialysis (patient 4) showed significantly higher sTREM-1 values (4.06±1.22 vs. 2.86±0.51 ng/ml, P<0.001, and 5.27±1.2 vs. 3.55±1.05 ng/ml, P<0.05). Fair correlation could be detected between the sepsis-related organ failure assessment scoring system and sTREM-1 on day 1 and 7 (r=0.45, P<0.05 and r=0.47, P<0.05). In patients who developed AKI (12 patients), sTREM-1 showed significantly higher values than those who did not develop AKI (4.37±1.34 vs. 3.39±0.95 ng/ml, P<0.05). Compared with the survivors, the nonsurvivors (14 patients) showed significantly higher sTREM-1 values (4.6±1.14 vs. 2.96±0.52 ng/ml, P<0.001). The area under the curve for sTREM-1 to predict AKI on day 1 was 0.73 (95% confidence interval: 0.53–0.92), with the best cut-off value at 4.02 ng/ml (sensitivity 66.7% and specificity 83.3%). The area under the curve for sTREM-1 to predict the ICU mortality on day 1 was 0.91 (95% confidence interval: 0.81–1.01), with the best cut-off value at 4.02 ng/ml (sensitivity 73.3% and specificity 100%). Conclusion Urinary sTREM-1 can be used as a clinical outcome predictor for the development of AKI and ICU mortality in patients with sepsis.