THE PROGNOSTIC VALUE OF SERUM STREM-1 AND PCT COMBINED WITH PRO-ADM IN PATIENTS WITH VENTILATOR-ASSOCIATED PNEUMONIA

Shutao Zou¹, Jun Xie², Yuanhang Jia³, Lin Chen^{3, *}

¹Department ofPulmonary and Critical Care Medicine, First People's Hospital of Bijie City, Bijie, PR China - ²Department of General Practice, First People's Hospital of Bijie City, Bijie, PR China - ³Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of University of South China, Hengyang, PR China

Objective: To analyse the prognostic value of serum soluble myeloid cell trigger receptor-1 (sTREM-1), procalcitonin (PCT) and adrenal myelinogen (pro-ADM) in patients with ventilator-associated pneumonia.

Methods: From May 2017 to May 2019 96 patients undergoing mechanical ventilation in our intensive care unit (ICU) were selected to be the observation group This group was further divided into the group of patients who died within 28 days (45 cases) and those who survived beyond that time (51 cases). In addition, 40 patients without VAP who underwent mechanical ventilation in our hospital during the same period were selected as the control group. Data collected for all patients included age, gender, the APACHE II score, the pulmonary infection score, and the duration of mechanical ventilation. The changes of sTREM-1, PCT and pro-ADM levels in each group on day 1, day 3 and day 5 were compared. ROC curve analysis examined the prognostic value of sTREM-1, PCT and pro-ADM in VAP patients, and logistic regression analysis was used to analyse the risk factors for death within 28 days.

Results: In the group that died, the APACHE II score and CPIS score were significantly higher than in the survival group, and the difference was statistically significant (p<.01). For the patients who died, the levels of sTREM-1, PCT and pro-ADM after VAP diagnosis were significantly higher on day 1, day 3 and day 5 than the levels in the survival group, and the difference was statistically significant (p<.05). Over time, the levels of sTREM-1, PCT and pro-ADM in the survival group were significantly lower (p<.05), while the levels of sTREM-1, PCT and pro-ADM in the group that died were significantly higher (p<.05). ROC curve analysis showed that the area under the curve (AUC) of sTREM-1, PCT and pro-ADM was 0.845, 0.702, 0.756 and 0.915, respectively, for predicting the prognosis of VAP patients independently and in combination. The value of the three indicators combined in predicting the prognosis of VAP patients was significantly higher than that of the separate tests. Logistic regression analysis showed that the APACHE II rating, sTREM-1, PCT, pro-ADM are independent risk factors for the development of patients who die within 28 days (p<.05).

Conclusion: Serum sTREM-1 and PCT combined with pro-ADM have clinical value in predicting the condition of patients with ventilator-associated pneumonia, and all three indicators are independent risk factors for death within 28 days.