Soluble Triggering Receptor Expressed on Myeloid cell-1 Is Increased in Patients With Ventilator-Associated Pneumonia: A Preliminary Report

Chest. 2007 Jul;132(1):58-63. doi: 10.1378/chest.06-2731. Epub 2007 May 15.

Abstract

Rationale: The diagnosis of ventilator-associated pneumonia (VAP) can be difficult. Soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been reported to be elevated in BAL fluid from patients with VAP.

Objectives: To evaluate the utility of sTREM-1 in the diagnosis of VAP in BAL fluid and the fluid collected in the expiratory trap from the ventilator, the exhaled ventilator condensate (EVC).

Methods: We prospectively collected BAL fluid and EVC from 23 patients clinically suspected of having VAP. A sensitive enzyme-linked immunosorbent assay was developed to measure sTREM-1. The results derived from this assay were confirmed using an immunoblot technique. The presence of VAP was clinically determined using a modified clinical pulmonary infection score of > 6.

Results: VAP was diagnosed in 14 of 23 patients. sTREM-1 was detected in the EVC from 11 of 14 subjects with VAP, but from only 1 of 9 subjects without VAP, and was significantly higher in the pneumonia patients and when expressed as picograms per milliliter or picograms per microgram protein (p = 0.005, both comparisons). In contrast, sTREM-1 was detected in the BAL fluid of all 14 VAP subjects but also in 8 of 9 subjects with no pneumonia, and did not differ in the VAP subjects compared to the nonpneumonia subjects when expressed as picrograms per milliliter or picograms per microgram protein (p > 0.05 both comparisons).

Conclusion: sTREM-1 is detectable in EVC and may be useful in establishing or excluding the diagnosis of VAP.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breath Tests / methods
  • Bronchoalveolar Lavage Fluid / chemistry
  • Enzyme-Linked Immunosorbent Assay
  • Gene Expression Regulation
  • Humans
  • Membrane Glycoproteins / genetics
  • Membrane Glycoproteins / metabolism*
  • Pneumonia, Ventilator-Associated / diagnosis*
  • Pneumonia, Ventilator-Associated / genetics
  • Pneumonia, Ventilator-Associated / metabolism*
  • Prospective Studies
  • Receptors, Immunologic / genetics
  • Receptors, Immunologic / metabolism*
  • Triggering Receptor Expressed on Myeloid Cells-1

Substances

  • Membrane Glycoproteins
  • Receptors, Immunologic
  • TREM1 protein, human
  • Triggering Receptor Expressed on Myeloid Cells-1