Prognosis of community acquired pneumonia (CAP): value of triggering receptor expressed on myeloid cells-1 (TREM-1) and other mediators of the inflammatory response.
TREM-1 is an activating receptor expressed on the surface of neutrophils and mature monocytes when stimulated by bacteria or fungi, leading to amplification of the inflammatory response. Our objective is to analyze the prognostic value of serum sTREM-1 levels and other mediators of the inflammatory response, in patients hospitalized for CAP, and to compare its prognostic value with those of advanced age, pneumonia severity scores, Charlson index, nutritional status and severity of sepsis.


METHODS
We included 226 patients with CAP, 145 males and 81 females, median age of 74 years. The following tests were performed: arterial blood gases and chest radiography, nutritional assessment, assessment of the severity of the sepsis, Pneumonia Severity Index (PSI) and CURB-65, and mediators of inflammation: TNF alfa, IL-6, IL-10, IL-1ra, LBP, sCD14, CRP, and sTREM-1. Mortality during admittance was defined as the sole end point.


RESULTS
Twenty-eight of the two-hundred and twenty-six patients died (12.4%). On univariate analysis advanced age, dehydration, increased Na, low BMI, handgrip strength, serum albumin, prealbumin, IGF-1, lymphocyte count, conscious drowsiness, tachypnea, decreased PaO2, hypotension, creatinine, ASAT, LDH, severity of sepsis, a high PSI or CURB65, TNFalpha, IL-6, IL-10, IL-1ra, and sTREM-1 were related to mortality. Variables with an independent value were IGF-1, CURB-65, TREM-1, advanced age and IL-6.


CONCLUSIONS
This study confirms the usefulness of TREM-1 in the diagnosis and prognosis of patients with CAP, which is independent of advanced age, other inflammation markers such as IL-6, severity index for CAP such as CURB-65 or PSI, severity of sepsis and nutritional status including IGF-1.
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna 38320, Tenerife, Spain.
Alicia
A
Tejera
Francisco
F
Santolaria
María-Luisa
ML
Diez
María-Remedios
MR
Alemán-Valls
Emilio
E
González-Reimers
Antonio
A
Martínez-Riera
Antonio
A
Milena-Abril
D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002352:Carrier Proteins / Q000097:blood; D017714:Community-Acquired Infections / Q000276:immunology* / Q000401:mortality; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000276:immunology* / Q000401:mortality; D011379:Prognosis; D011971:Receptors, Immunologic / Q000097:blood*; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002097:C-Reactive Protein; D002352:Carrier Proteins; D018836:Inflammation Mediators; D053590:Interleukin 1 Receptor Antagonist Protein; D016753:Interleukin-10; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D014409:Tumor Necrosis Factor-alpha; D000099231:Lipopolysaccharide-Binding Protein; C508609:IL10 protein, human; C508600:IL6 protein, human; C408842:TREM1 protein, human