Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid of patients with pulmonary infiltrates in the ICU.
OBJECTIVE
Prospective single-center study to determine whether the presence of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has diagnostic utility in patients with pulmonary infiltrates receiving mechanical ventilation and undergoing BAL.


METHODS
Prospective cohort study.


METHODS
Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.


METHODS
Adult patients with acute respiratory failure undergoing BAL for pulmonary infiltrates.


METHODS
BAL fluid measurement of sTREM-1 concentration using a Quantikine Human TREM-1 Immunoassay (R&D Systems; Minneapolis, MN).


RESULTS
A total of 105 consecutive patients receiving mechanical ventilation and undergoing BAL were enrolled. Of those, 19 patients (18.1%) met definite microbiologic criteria for bacterial or fungal ventilator-associated pneumonia (VAP). Though the mean sTREM-1 concentration was greater in patients with definite VAP (n = 19; 171.9 +/- 158.7 pg/mL) than in patients with definite absence of VAP (n = 21; 96.7 +/- 76.2 pg/mL), this difference was not statistically significant (p = 0.06). A cutoff value for sTREM-1 > 200 pg/mL yielded a diagnostic sensitivity of 42.1% and a specificity of 75.6% for definite VAP. Patients with alveolar hemorrhage had the greatest values for sTREM-1 concentration (n = 9; 555 +/- 440 pg/mL). Receiver operating curve analysis and multivariate logistic regression analysis demonstrated that measurement of sTREM-1 was inferior to clinical parameters for the diagnosis of VAP.


CONCLUSIONS
Measurement of sTREM-1 in BAL fluid appears to have minimal diagnostic value for VAP.
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
Nitin J
NJ
Anand
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
Scott
S
Zuick
Division of Pulmonary, Occupational Medicine, and Critical Care, University of Iowa Hospitals and Clinics, Iowa City, IA.
Julia
J
Klesney-Tait
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO. Electronic address: mkollef@im.wustl.edu.
Marin H
MH
Kollef
D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000166:cytology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis*; D008875:Middle Aged; D009504:Neutrophils; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000032:analysis*; D012131:Respiratory Insufficiency / Q000628:therapy; D012680:Sensitivity and Specificity; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D015415:Biomarkers; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1