title: Soluble triggering receptor expressed on myeloid cells 1: a biomarker for bacterial meningitis.
abstract: OBJECTIVE
  To evaluate whether soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in CSF can serve as a biomarker for the presence of bacterial meningitis and outcome in patients with this disease.
  
  
  METHODS
  Retrospective study of diagnostic accuracy.
  
  
  METHODS
  CSF was collected from 92 adults with community-acquired bacterial meningitis who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects.
  
  
  RESULTS
  CSF sTREM-1 levels were higher in patients with bacterial meningitis (median 82 pg/ml, range 0-988) than in those with viral meningitis (0 pg/ml, 0-48) and controls (0 pg/ml, 0-36). The diagnostic accuracy of sTREM-1 in discriminating between patients with and without bacterial meningitis, expressed as the area under the receiver operating characteristic curve, was 0.82. At a cutoff level of 20 pg/ml the sensitivity was 0.73 and specificity 0.77. In patients with bacterial meningitis CSF sTREM-1 levels were associated with mortality (survivors, median 73 pg/ml, range 0-449 pg/ml; nonsurvivors, 15 pg/ml, 0-988).
  
  
  CONCLUSIONS
  Measuring sTREM-1 in CSF may be a valuable new additional approach to accurately diagnose bacterial meningitis and identify patients at high risk for adverse outcome. Therefore a prospective study of sTREM-1 as a biomarker in bacterial meningitis is needed.
authors.affiliation: Department of Intensive Care Medicine, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: Martijn
authors.initials: M
authors.lastname: Weisfelt
authors.forename: Jan
authors.initials: J
authors.lastname: de Gans
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D015415:Biomarkers / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D006801:Humans; D008562:Membrane Glycoproteins / Q000134:cerebrospinal fluid*; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D011971:Receptors, Immunologic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D015415:Biomarkers; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1