Assessment of bacterial infection by serum CRP and sTREM-1 levels in patients with hepatitis B virus-associated acute-on-chronic liver failure
Objective The purpose of this study was to investigate the diagnostic efficacy of serum C-reactive protein(CRP)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)levels for secondary infections in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Methods 96 consecutive patients with HBV-ACLF were encountered in our hospital between February 2020 and February 2023.Serum CRP and sTREM-1 levels were measured by ELISA.The multivariate Logistic regression analysis was conducted to identify the influencing factors for secondary infections in patients with HBV-ACLF.The diagnostic performance of above parameters was evaluated by using the receiver operating characteristic(ROC)curve.Results 67(69.8%)patients with HBV-ACLF in our series developed secondary infections,and the spontaneous bacterial peritonitis,pulmonary infection,urinary tract infection,biliary tract infection,intestinal infection,and skin and soft tissue infection accounted for 40.3%,31.3%,11.9%,4.5%,4.5%,and 7.5%,respectively;the model of end-stage liver disease score and chronic liver failure sequential organ failure assessment score in patients with infection were(15.7±3.0)and(8.5±1.1),both significantly greater than[(12.40±3.00)and(6.1±1.0),P<0.05]in patients without infection;serum CRP and sTREM-1 levels in patients with infection were(52.2±4.6)mg/L and(29.9±5.8)pg/mL,both much higher than[(10.1±3.3)mg/L and(13.3±4.1)pg/mL,P<0.05]in those without;the Logistic regression analysis showed that the international normalization ratio,serum CRP,sTREM-1 and procalcitonin levels were all the independent risk factors for secondary infection(P<0.05);the ROC analysis demonstrated that the AUC was0.906,with the sensitivity of 98.5%and the specificity of 82.8%,when serum CRP and sTREM-1 level combination was applied to predict the existence of infection,much superior to any parameter alone(P<0.05).Conclusion The surveillance of serum CRP and sTREM-1 level could help diagnose the secondary infections in patients with HBV-ACLF,which needs further clinical investigation.
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