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Original Research: RESPIRATORY INFECTION |

Diagnostic Implications of Soluble Triggering Receptor Expressed on Myeloid Cells-1 in BAL Fluid of Patients With Pulmonary Infiltrates in the ICU

Nitin J. Anand, MD; Scott Zuick, MD; Julia Klesney-Tait, MD, PhD; Marin H. Kollef, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Drs. Anand, Zuick, and Kollef), Washington University School of Medicine, St. Louis, MO; and Division of Pulmonary, Occupational Medicine, and Critical Care (Dr. Klesney-Tait), University of Iowa Hospitals and Clinics, Iowa City, IA.

Correspondence to: Marin H. Kollef, MD, FCCP, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@im.wustl.edu


This work was supported by a grant from the Barnes-Jewish Hospital Foundation.

The authors have no conflicts of interest to disclose regarding this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):641-647. doi:10.1378/chest.08-1829
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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.

Design:  Prospective cohort study.

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

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

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

Measurements and main 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.

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