The utility of sTREM-1 and presepsin to predict infection in pediatric patients receiving mechanical circulatory support

Background: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes. Methods: We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection. Results: Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462–30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77–0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods. Conclusion: Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.