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Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia

Sébastien Gibot1, Aurélie Cravoisy, Bruno Levy

  • 1Service de Réanimation Médicale, Hôpital Central, Nancy, France. s.gibot@chu-nancy.fr

The New England Journal of Medicine
|January 30, 2004
PubMed
Abstract

Insights

Diagnosing pneumonia in mechanically ventilated patients is challenging. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in bronchoalveolar lavage fluid accurately identifies bacterial or fungal pneumonia.

Area of Science:

  • Critical Care Medicine
  • Immunology
  • Respiratory Medicine

Background:

  • Diagnosing bacterial pneumonia in mechanically ventilated patients presents significant clinical challenges.
  • Triggering receptor expressed on myeloid cells (TREM-1) expression increases on phagocytes due to microbial products.
  • Soluble TREM-1 (sTREM-1) in bronchoalveolar lavage fluid may serve as a pneumonia indicator in this population.

Purpose of the Study:

  • To evaluate the diagnostic utility of sTREM-1 in bronchoalveolar lavage fluid for pneumonia in mechanically ventilated patients.
  • To compare the accuracy of sTREM-1 detection with existing clinical and laboratory markers.

Main Methods:

  • A prospective study involved 148 mechanically ventilated patients with suspected infectious pneumonia.
  • Soluble TREM-1 (sTREM-1) levels were measured using a rapid immunoblot technique in bronchoalveolar lavage fluid.
  • Pneumonia diagnoses were independently assessed by two intensivists blinded to sTREM-1 results.

Main Results:

  • Pneumonia was diagnosed in 84 patients (38 community-acquired, 46 ventilator-associated); 64 patients had no pneumonia.
  • sTREM-1 detection demonstrated superior accuracy over clinical findings and lab values for identifying bacterial or fungal pneumonia (LR 10.38, sensitivity 98%, specificity 90%).
  • sTREM-1 was identified as the strongest independent predictor of pneumonia (OR 41.5) in logistic regression analysis.

Conclusions:

  • Rapid detection of sTREM-1 in bronchoalveolar lavage fluid can aid in diagnosing or excluding bacterial/fungal pneumonia in mechanically ventilated patients.
  • sTREM-1 shows promise as a valuable biomarker for pneumonia diagnosis in critical care settings.

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