Abstract
Objective. To investigate the effect of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum, bronchoalveolar lavage fluid (BALF), endotracheal aspiration (ETA), and exhaled breath condensate (EBC) samples as early biomarkers for the diagnosis of ventilator-associated pneumonia (VAP) in patients with ischemic stroke. Methods. One hundred and thirty-two patients with clinically suspected VAP were enrolled in this study. Bronchoscopy was performed on the day of clinically suspected VAP. sTREM-1 levels in serum, BALF, ETA, and EBC were measured. VAP was diagnosed by quantitative cultures of BALF (≥104 cfu/mL). Results. VAP was confirmed in 76 (57.58%) cases. Patients with VAP showed significantly higher sTREM-1 in BALF [32.35 (IQR, 30.08–41.72) versus 18.92 (11.89–31.72)] pg/mL and in EBC [1.57 (IQR, 1.02–2.61) versus 0.41 (0.19–1.61)] pg/mL than patients without VAP. The area under the curve was 0.813 (p < 0.001). The optimum cut-off value for sTREM-1 in BALF was 23.61 pg/mL, yielding sensitivity and specificity of 85.5% and 73.1%. sTREM-1 in BALF had excellent correlation with that in EBC (R2 = 0.78, p < 0.05). Conclusions. sTREM-1 in EBC and BALF had good diagnostic performance in differentiating patients with and without VAP.
Highlights
Ventilator-associated pneumonia (VAP) which constitutes a frequent infection in intensive care unit (ICU) patients consumes vast healthcare resources and increases proportionally to the duration of ICU stay and mortality [1]
The triggering receptor expressed on myeloid cells-1 (TREM-1) is a member of the immunoglobulin superfamily
A soluble form of TREM-1 was proposed as a new biomarker which had been tested for acute infections with different diagnostic and prognostic value [4]. sTREM-1 can be found in different body fluids, such as serum, bronchoalveolar lavage fluid (BALF), endotracheal aspiration (ETA), and exhaled breath condensate (EBC), where it can be assayed by ELISA using commercial immunoassay kits [5]
Summary
Ventilator-associated pneumonia (VAP) which constitutes a frequent infection in intensive care unit (ICU) patients consumes vast healthcare resources and increases proportionally to the duration of ICU stay and mortality [1]. In patients with ischemic stroke who are characterized by advanced age, depressed level of consciousness, immune suppression, and long-term bed rest, the incidence of VAP can increase to approximately 40%, which is associated with a less favorable neurologic and functional outcome [2]. Diagnosis of VAP with clinical suspicion is overly sensitive with low specificity, leading to unnecessary antibiotics use [3], and the incidence of VAP among ICU ischemic stroke patients has not been thoroughly investigated. A soluble form of TREM-1 (sTREM-1) was proposed as a new biomarker which had been tested for acute infections with different diagnostic and prognostic value [4]. Some clinical studies have proved that sTREM-1 did have the ability to identify patients with sepsis while others come to an opposite conclusion [6, 7]
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