sTREM-1 predicts intensive care unit and 28-day mortality in cancer patients with severe sepsis and septic shock

Abstract Introduction The innate immune response molecules and their use as a predictor of mortality in cancer patients with severe sepsis and septic shock are poorly investigated. Objective To analyze the value of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor α (TNF-α), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and high-mobility group box 1 (HMGB-1) as predictors of mortality in cancer patients with severe sepsis and septic shock compared with septic patients without malignancies. Design Prospective, observational cohort study. Setting Tertiary level adult intensive care unit (ICU). Subjects Seventy-five patients with severe sepsis or septic shock, 40 with cancer and 35 without. Interventions and Measurements Laboratory data were collected at ICU admission, 24and 48 hours after. Plasma concentrations of HMGB-1 and sTREM-1 were measured by enzyme-linked immunosorbent assay, whereas cytokines were measured by cytometric bead array. Results Intensive care unit mortality in cancer and noncancer patients was 40% and 28.6% ( P = .29), and 28-day mortality was 45% and 34.3% ( P = .34). Proinflammatory cytokines IL-1ß, IL-6, IL-8, IL-12, and TNF-α showed significantly higher values in the cancer group. Interleukin-10 at 48 hours ( P = .01), sTREM-1 in all measurements ( P < .01) and HMGB-1 at 24 hours ( P < .01) showed significantly lower values in the cancer group. In addition, for the cancer group, sTREM-1 at 24 hours ( P = .02) and 48 hours ( P = .01) showed higher levels in nonsurvivors patients. The area under the receiver operating characteristic curve for predicting ICU mortality for sTREM-1 was 0.73 (95% confidence interval, 0.57-0.89; P = .01). Multivariate logistic analysis showed that the days spent in mechanical ventilation and levels of sTREM-1 and IL-1ß at 48 hours were independent predictors of ICU mortality; corticosteroids requirement and levels of sTREM-1 and TNF-α at 24 hours were independent predictors of 28-day mortality. Conclusions Patients with cancer have different immune profile in sepsis when compared with patients without cancer, as demonstrated for levels of cytokines, sTREM-1 and HMGB-1. sTREM-1 and days spent in mechanical ventilation proved to be good predictors of ICU and 28-day mortality in cancer patients.