Role of Soluble Triggering Receptors Expressed on Myeloid Cells -1 and 25-Hydroxy Vitamin D as Early Predictors of Neonatal Ventilator Associated Pneumonia

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Abstract Ventilator associated pneumonia (VAP) is considered one of the most nosocomial pneumoniae in ventilated neonates. Yet, its diagnosis is very difficult due to non-specific clinical parameters and the lack of sensitive biomarker. The main objective of this study was to assess comparison between soluble triggering receptors expressed on myeloid cells -1 (sTREM-1) and 25-hydroxy vitamin D as early predictors of neonatal VAP. This prospective cohort study included 85 ventilated neonates who were divided into two groups; VAP group (n = 33) and non-VAP group (n = 52). sTREM-1 level in the endotracheal aspirate (ETA) and serum 25-Hydroxy vitamin D were measured on the third and seventh days following mechanical ventilation. sTREM-1 cutoff value of > 0.46 and > 0.44 ng/ml at 3 and 7 days had a sensitivity of 93.94% and 96.97%, a specificity of 92.31% and 100%, and area under the receiver operating characteristic curve (AUC) of 0.963 and 0.993 respectively to predict the development of neonatal VAP. A cutoff value of ≤17.5 ng/ml for serum 25-Hydroxy vitamin D at 3 and 7 days had a sensitivity of 90.91% and 81.82%, a specificity of 75% and 78.85%, and AUC of 0.877 and 0.939 respectively.Conclusion: Both sTREM-1 in ETA and serum 25-Hydroxy vitamin D could be used as early predictors of neonatal VAP, but sTREM-1 appears to be more useful.

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