title: Infectious pleural effusions can be identified by sTREM-1 levels.
abstract: OBJECTIVE
  Conventional methods to establish pleural infection are time-consuming and sometimes inadequate. Biomarkers may aid in making rapid diagnosis of infection. In an observational study we evaluated and compared the diagnostic value of pleural fluid levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein and procalcitonin in intensive care patients with pleural effusions.
  
  
  METHODS
  Thirty-six patients with de novo pleural effusions were included and 20 patients with pleural effusions after cardiothoracic surgery and 20 patients with pleural effusions after esophagus surgery acted as controls. Levels of sTREM-1, C-reactive protein and procalcitonin were measured in pleural effusions.
  
  
  RESULTS
  Levels of sTREM-1 were highest in empyemas, followed by infectious exudates. Levels of sTREM-1 were low in transudates and non-infectious exudates. C-reactive protein levels were highest in exudates and empyemas, while procalcitonin levels were highest in exudates. Pleural fluid with positive culture results contained higher sTREM-1 and C-reactive protein levels as compared to samples with negative culture results. A cut-off level of 50pg/mlsTREM-1 yielded a sensitivity of 93% and a specificity of 86%, while these were 87% and 67% respectively for a cut-off value of 7.5microg/ml C-reactive protein, and 60% and 64% respectively for a cut-off value of 0.15 ng/ml procalcitonin.
  
  
  CONCLUSIONS
  sTREM-1 is superior to C-reactive protein and procalcitonin in detecting infection.
authors.affiliation: Academic Medical Center, Department of Intensive Care, Amsterdam, The Netherlands. r.m.determann@amc.uva.nl
authors.forename: R M
authors.initials: RM
authors.lastname: Determann
authors.forename: A A
authors.initials: AA
authors.lastname: Achouiti
authors.forename: A A
authors.initials: AA
authors.lastname: El Solh
authors.forename: P
authors.initials: P
authors.lastname: Bresser
authors.forename: J
authors.initials: J
authors.lastname: Vijfhuizen
authors.forename: P E
authors.initials: PE
authors.lastname: Spronk
authors.forename: M J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000032:analysis*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis*; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis* / Q000378:metabolism; D011498:Protein Precursors / Q000032:analysis*; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000032:analysis*; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide