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sTREM-1 and LBP in Central Venous Catheter–associated Bloodstream Infections in Pediatric Intestinal Failure

Kevan, Emily N.; Simmons, Julia R.; Kocoshis, Samuel A.; Cohen, Mitchell B.; Rudolph, Jeffrey A.

Journal of Pediatric Gastroenterology & Nutrition: December 2011 - Volume 53 - Issue 6 - p 627–633
doi: 10.1097/MPG.0b013e3182294fcc
Original Articles: Hepatology and Nutrition

Objective: Central venous catheter–associated bloodstream infections (CVC-BSIs) are a major cause of morbidity and mortality in the pediatric intestinal failure (IF) population. We assessed plasma lipopolysaccharide-binding protein (LBP) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as biomarkers for CVC-BSI. We hypothesized that sTREM-1 and LBP rise with BSI and decline following treatment, and that baseline LBP is higher in the IF population than in controls.

Patients and Methods: Patients younger than 4 years were recruited from the IF registry at Cincinnati Children's Hospital. LBP and sTREM-1 levels were measured on 22 patients with IF at baseline, 17 patients with IF with BSIs, and 11 healthy controls.

Results: Mean sTREM-1 level (pg/mL) and LBP level (μg/mL) rose with CVC-BSI over baseline (115.0 ± 51.2 vs 85.9 ± 27.6, P = 0.011 and 79.8 ± 45.4 vs 20.5 ± 11.3, P < 0.001, respectively) and declined following antibiotic therapy (115.0 ± 51.2 vs 77.9 ± 29.8, P = 0.003 and 79.8 ± 45.4 vs 26.2 ± 10.8, P < 0.001, respectively). Receiver operating characteristic curves showed that neither sTREM-1 nor LBP is sufficient to predict bacteremia versus fever without bacteremia (area under these curves = 0.57 and 0.82, respectively). Baseline LBP was higher in hospitalized patients than in outpatients (27.5 ± 8.7 vs 13.5 ± 9.2, P = 0.002), patients with previous BSIs versus those without (23.5 ± 10.4 vs 10.1 ± 8.3, P = 0.016), and those listed for transplantation versus those not listed (29.6 ± 9.8 vs 16.2 ± 9.5, P = 0.033).

Conclusions: sTREM-1 and LBP rise with CVC-BSI in IF and decline after treatment; however, neither distinguishes infection from nonbacteremic febrile episodes. Baseline LBP may be a marker of disease severity in IF.

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Emily N. Kevan, MD, Division of Gastroenterology, Greenville Hospital System, 200 Patewood Dr, Ste 140A, Greenville, SC 29615 (e-mail: ekevan@ghs.org).

Received 17 August, 2010

Accepted 14 June, 2011

The authors report no conflicts of interest.

The study received funds from USPHS grant T32 DK07727 Training Program in Pediatric Gastroenterology and Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Academic Health Center, and Clinical and Translational Science Award 1UL1RR026314.

Copyright 2011 by ESPGHAN and NASPGHAN