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Previous Volume 350:451-458 January 29, 2004 Number 5 Next

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ABSTRACT

Background The diagnosis and treatment of bacterial pneumonia in patients who are receiving mechanical ventilation remain a difficult challenge. The triggering receptor expressed on myeloid cells (TREM-1) is a member of the immunoglobulin superfamily, and its expression on phagocytes is specifically up-regulated by microbial products. The presence of soluble TREM-1 (sTREM-1) in bronchoalveolar-lavage fluid from patients receiving mechanical ventilation may be an indicator of pneumonia.

Methods We conducted a prospective study of 148 patients receiving mechanical ventilation in whom infectious pneumonia was suspected. A rapid immunoblot technique was used to measure sTREM-1 in bronchoalveolar-lavage fluid. Two independent intensivists who were unaware of the results of the sTREM-1 assay determined whether community-acquired pneumonia and ventilator-associated pneumonia were present or absent.

Results The final diagnosis was community-acquired pneumonia in 38 patients, ventilator-associated pneumonia in 46 patients, and no pneumonia in 64 patients. The presence of sTREM-1 by itself was more accurate than any clinical findings or laboratory values in identifying the presence of bacterial or fungal pneumonia (likelihood ratio, 10.38; sensitivity, 98 percent; specificity, 90 percent). In multiple logistic-regression analysis, the presence of sTREM-1 was the strongest independent predictor of pneumonia (odds ratio, 41.5).

Conclusions In patients receiving mechanical ventilation, rapid detection of sTREM-1 in bronchoalveolar-lavage fluid may be useful in establishing or excluding the diagnosis of bacterial or fungal pneumonia.

Source Information

From Réanimation Médicale, Hôpital Central (S.G., A.C., B.L., P.-E.B.), and Laboratoire d'Immunologie, Faculté de Médecine (M.-C.B., G.F.) — both in Nancy, France.

Address reprint requests to Dr. Gibot at the Hôpital Central, Service de Réanimation Médicale, 29 ave. du Maréchal de Lattre de Tassigny, 54035 Nancy CEDEX, France, or at s.gibot{at}chu-nancy.fr.

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Soluble TREM-1 and the Diagnosis of Pneumonia
Hugues G., Olivier L., Benoit G., Allaouchiche B., Boselli E., Gibot S., Levy B., Béné M.-C.
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N Engl J Med 2004; 350:1904-1905, Apr 29, 2004. Correspondence

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