Is Triggering Receptor Expressed On Myeloid Cells 1 (TREM-1) protein a new marker of serious infectious complications in colorectal surgery? – case-matched pilot study

Purpose: The purpose of the study was to evaluate the usefulness of the Triggering Receptor Expressed On Myeloid Cells 1 (TREM-1) protein as a marker for serious infectious complications during laparoscopic colorectal surgery. Methods: 64 patients with colon or rectal cancer, who underwent an elective laparoscopic colorectal cancer surgery from November 2018 to February 2020, were included in the analysis. Blood samples of the TREM-1 protein testing were collected four times from each patient: before and on three following postoperative days (PODs). Patients were divided into two groups according to the presence of infectious complications. Subsequently, patients with infectious complications (group 1) were matched 1:1 with patients without complications (group 2). The case-matched analysis was done by selecting patients from the control group by age, ASA scale, cancer stage, and type of surgery. Results: There was no significant difference in demographic and operative characteristics between the two groups. The median length of hospital stay was longer in Group 1 than in Group 2 (11 days vs. 5 days, p<0.001). Preoperative measurements of TREM-1 protein did not differ between the two groups. There were no significant differences in the measurements on the first and third postoperative days. However, the median TREM-1 measurement was higher in Group 1 on the second postoperative day (542 pg/ml vs. 399 pg/ml; p=0.040). The difference was more apparent when only severe postoperative complications were considered. When compared to the group without any complications, the median TREM-1 level was significantly higher in the group with severe infection complications in POD 1, POD 2, and POD 3 (p<0.05). The receiver operating characteristic (ROC) curve demonstrated that TREM-1 readings in 2 POD had sensitivity of 83% and specificity of 84% for the presence of severe infection complications at a value of 579.3 pg/ml (AUC 0.8, 95%CI 0.65-0.96). Conclusion: TREM-1 measurements might become a helpful predictive marker in the early diagnosis of serious infectious complications in patients following laparoscopic colorectal surgery. Trial registration number: NCT05933408, date of registration: 6 July 2023, retrospectively registered