Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) as a New Marker in Ventilated Children with Pneumonia

Abstract

Pneumonia is the world's leading infectious cause of mortality. This is one of the most common lower respiratory tract infections, which contributes significantly to the burden of antibiotic use. Because of the complexity of the pathophysiology, pneumonia is widely recognized that the clinical diagnosis and prognosis are usually not enough to accurately estimate the severity of the condition. The most difficult task for a doctor is above all the value of risk in patients with community-acquired pneumonia. Early diagnosis is important to reduce hospitalization and death. There are widespread biomarkers, none of which look perfect, and the demand for new biomarkers that maximizes the severity and treatment response for pneumonia has increased lately. Ventilation-related pneumonia (VAP) is a hospital-acquired pneumonia that can occur more than 48 hours after mechanical ventilation. This is a common complication of mechanical ventilation, which has a high mortality rate. VAP can make it difficult for patients to turn off the ventilator and cause longer hospitalizations, which can cause a very large financial burden for patients and the need for large medical resources. The incidence and mortality of VAP have decreased with the progress of prevention strategies in the last few decades. However, VAP is still one of the most common causes of nosocomial infections and a frequent cause of death in intensive care units. Current challenges in VAP treatment include the lack of a gold standard for diagnosis, the lack of effective prevention strategies, and increased antibiotic resistance. Active receptors are expressed on myeloid cells (TREM-1) and are considered to be glycoprotein members of the immunoglobulin family. TREM-1 is an inflammatory receptor that causes inflammation after exposure to extracellular fungi and bacterial pathogens. Elevated TREM-1 levels are a potential marker of lung disease. The aim of this study is to evaluate sTREM-1 levels in the serum of pneumonia patients and their use as new biomarkers, which seem promising for accurate diagnosis, risk and follow-up of VAP, always, however, one of the most common causes is nosocomial infection and one of the leading causes of death most commonly in intensive care units. A comparative study was conducted on children diagnosed with pneumonia admitted to Pediatric Abo El Rish Intensive Care Unit and Abo El Rish Pediatric Hospital, Cairo University, compared to age and sex-matched healthy control group. sTREM-1 level was measured using ELISA technique while CRP by Nephelometry. TREM-1 level was significantly higher in ventilated children with pneumonia compared to the control group. No significant correlation was found between sTREM-1 level and CRP level in the studied children. TREM-1 is not a pulmonary infection marker only but a reliable marker for ventilator-associated pneumonia (VAP).