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sTREM2 in the prognostic evaluation of acute lung injury after cardiac surgery in infants

Pediatric Research volume 95, pages 770–774 (2024)Cite this article

Abstract

Background

Previous studies have shown that TREM2 plays a protective role in acute lung injury (ALI). This prospective study aimed to investigate the role of sTREM2 as a forecasting factor for ALI in infants after pediatric cardiac surgery undergoing cardiopulmonary bypass (CPB).

Methods

Seventy-five consecutive patients younger than 1 year who underwent cardiac surgery were enrolled in this study. Sixty-one fulfilled the inclusion criteria and had been divided into ALI and non-ALI groups. Children’s demographic characteristics and clinical data were collected. Perioperative sTREM2 levels were analyzed at five timepoints.

Results

In this study, children in the ALI group were younger, lighter, with higher RACHS-1 scores and underwent significantly longer CPB time. Post-CPB ALI had an impact on clinical outcomes, which contributed to a longer duration of mechanical ventilation, ICU and hospital stay than non-ALI group. Significant differences were manifested off-CPB, 1 h/6 h after CPB, and day 1 after surgery between the two groups. Binary logistic models revealed that off-CPB sTREM2 was significantly associated with the incidence of post-CPB ALI after adjustment. ROC analysis showed that the AUC of off-CPB sTREM2 level was 0.791, and the optimal cutoff value was 788.6 pg/ml.

Conclusions

The off-CPB sTREM2 level was an independent prognostic factor for post-CPB ALI in infants.

Impact

  • Plasma sTREM2 works together with downstream TREM2 to regulate inflammation response by binding the receptor to other cells. Previous studies have shown that TREM2 plays a protective role in ischemia-reperfusion and has anti-inflammatory effects on acute lung injury (ALI).

  • This study analyzed the risk factors of post-cardiopulmonary bypass (CPB) ALI. We found that weight and off-CPB sTREM2 level were independent prognostic factors for post-CPB ALI.

  • Plasma sTREM2 may serve as an early biomarker in the prognostic evaluation of acute lung injury after cardiac surgery in infants.

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Fig. 1: Perioperative courses over time of plasma sTREM2 levels in the ALI and non-ALI groups.
Fig. 2: ROC curve for weight, sTREM2 level at t2 as well as the combination of sTREM2 level at t2 with weight to predict post-CPB ALI.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

My deepest gratitude goes first and foremost to Professor Qiang Shu, for his constant encouragement and guidance. Second, I would like to express my thanks to my colleagues who have contributed to this article.

Funding

This research was supported by the Health Science and Technology Program of Zhejiang Province, China (2022KY865); the Fundamental Research Funds for the Central Universities, China (226-2022-00060).

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Author notes

  1. These authors contributed equally: Lijun Yang, Mingwei Sun.

Authors and Affiliations

  1. Department of Extracorporeal Circulation and Extracorporeal Life Support, Heart Institute, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou, Zhejiang, China

    Lijun Yang, Mingwei Sun, Wenting Zhao & Ru Lin

  2. Department of Cardiac Surgery, Heart Institute, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou, Zhejiang, China

    Liyang Ying, Xiwang Liu & Qiang Shu

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Contributions

L.Y. and M.S. jointly supervised this work. All authors contributed to the study conception and design, material preparation, data collection and interpretation of data. L. Yang performed analysis and wrote the first draft of the manuscript. All the authors commented on previous versions of the manuscript and revised it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qiang Shu.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was in line with the principles of the Declaration of Helsinki. The study was approved by Zhejiang University School of Medicine Children’s Hospital Ethic Committee on Clinical Investigation (2022-IRB-052). Informed consent was obtained from each participating individual’s guardian.

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Yang, L., Sun, M., Ying, L. et al. sTREM2 in the prognostic evaluation of acute lung injury after cardiac surgery in infants. Pediatr Res 95, 770–774 (2024). https://doi.org/10.1038/s41390-023-02915-5

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