title: Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in patients with acute respiratory distress syndrome and abdominal diseases: a preliminary observational study.
abstract: BACKGROUND
  Patients admitted to the intensive care unit (ICU) because of acute or decompensated chronic abdominal disease and acute respiratory failure need to have the potential infection diagnosed as well as its site (pulmonary or abdominal). For this purpose, we measured soluble triggering receptor expression on myeloid cells-1 (sTREM-1) in alveolar and peritoneal fluid.
  
  
  METHODS
  Consecutive patients (n = 21) with acute or decompensated chronic abdominal disease and acute respiratory failure were included. sTREM was measured in alveolar (A-sTREM) and peritoneal (P-sTREM) fluids.
  
  
  RESULTS
  An infection was diagnosed in all patients. Nine patients had a lung infection (without abdominal infection), 5 had an abdominal infection (without lung infection) and seven had both infections. A-sTREM was higher in the patients with pneumonia compared to those without pneumonia (1963 ng/ml (1010-3129) vs. 862 ng/ml (333-1011); P 0.019). Patients with abdominal infection had an increase in the P-sTREM compared to patients without abdominal infection (1941 ng/ml (1088-3370) vs. 305 ng/ml (288-459); P < 0.001). A cut-off point of 900 pg/ml of A-sTREM-1 had a sensitivity of 81% and a specificity of 80% (NPV 57%; PPV 93%, AUC 0.775) for the diagnosis of pneumonia. In abdominal infections, a cut-off point for P-sTREM of 900 pg/ml had the best results (sensitivity 92%; specificity 100%; NPV 90%, PPV 100%, AUC = 0.903).
  
  
  CONCLUSIONS
  sTREM-1 measured in alveolar and peritoneal fluids is useful in assessing pulmonary and peritoneal infection in critical-state patients-A-sTREM having the capacity to discriminate between a pulmonary and an extra-pulmonary infection in the context of acute respiratory failure.
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario la Fe, Avda, Campanar 21, 46009 Valencia, Spain. ramirez_pau@gva.es
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
authors.forename: Pedro
authors.initials: P
authors.lastname: Kot
authors.forename: Veronica
authors.initials: V
authors.lastname: Marti
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Gomez
authors.forename: Raquel
authors.initials: R
authors.lastname: Martinez
authors.forename: Vicente
authors.initials: V
authors.lastname: Saiz
authors.forename: Francisco
authors.initials: F
authors.lastname: Catala
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
mesh_terms: D000208:Acute Disease; D000328:Adult; D001202:Ascitic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002908:Chronic Disease; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000175:diagnosis*; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis*; D008875:Middle Aged; D011446:Prospective Studies; D011971:Receptors, Immunologic / Q000032:analysis*; D012128:Respiratory Distress Syndrome / Q000378:metabolism; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; 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