Abstract
BackgroundDifferential diagnosis of patients with bilateral lung infiltrates remains a difficult problem for intensive care clinicians. Here we evaluate the diagnostic role of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in bronchoalveolar lavage (BAL) specimens from patients with bilateral lung infiltrates.MethodsWe conducted a prospective observational study on 80 patients with bilateral lung infiltrates with clinical suspicion of infectious pneumonia. Patients were categorized into three groups: bacterial or fungal infection, intracellular or viral infection, and noninfectious inflammatory disease. sTREM-1 concentrations were measured, and BAL fluid and Clinical Pulmonary Infection Score (CPIS) were analyzed.ResultsThe sTREM-1 concentration was significantly increased in patients with bacterial or fungal pneumonia (n = 29, 521.2 ± 94.7 pg/ml), compared with that in patients with viral pneumonia, atypical pneumonia or tuberculosis (n = 14, 92.9 ± 20.0 pg/ml) or noninfectious inflammatory disease (n = 37, 92.8 ± 10.7 pg/ml). The concentration of sTREM-1 in BAL fluid, but not CPIS, was an independent predictor of bacterial or fungal pneumonia, and a cutoff value of more than 184 pg/ml yielded a diagnostic sensitivity of 86% and a specificity of 90%.ConclusionThe sTREM-1 level in BAL fluid from patients with bilateral lung infiltrates is a potential marker for the differential diagnosis of pneumonia due to extracellular bacteria.
Highlights
Differential diagnosis of patients with bilateral lung infiltrates remains a difficult problem for intensive care clinicians
The concentration of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in bronchoalveolar lavage (BAL) fluid, but not Clinical Pulmonary Infection Score (CPIS), was an independent predictor of bacterial or fungal pneumonia, and a cutoff value of more than 184 pg/ml yielded a diagnostic sensitivity of 86% and a specificity of 90%
The sTREM-1 level in BAL fluid from patients with bilateral lung infiltrates is a potential marker for the differential diagnosis of pneumonia due to extracellular bacteria
Summary
Differential diagnosis of patients with bilateral lung infiltrates remains a difficult problem for intensive care clinicians. Diverse presumptive clinical diagnoses of bilateral lung infiltrates include severe pneumonia induced by bacteria, virus, fungi or tuberculosis, and noninfectious inflammatory diseases caused by collagen vascular disease associated with interstitial lung disease, acute exacerbation of interstitial lung disease, pulmonary edema, acute respiratory distress syndrome or druginduced lung disease [1]. To enhance the specificity of clinical criteria for diagnosing ventilator-associated pneumonia, the Clinical Pulmonary Infection Score (CPIS) was introduced, which showed a high diagnostic accuracy for ventilator-associated pneumonia in some cases [2,3]. Gibot and colleagues showed that CPIS could differentiate between patients with and without pneumonia [4]. We evaluate the diagnostic role of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in bronchoalveolar lavage (BAL) specimens from patients with bilateral lung infiltrates
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