Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia

被引:20
作者
How, Chorng-Kuang [1 ,2 ,3 ]
Hou, Sen-Kuang [1 ,3 ,4 ]
Shih, Hsin-Chin [1 ,2 ]
Yen, David Hung-Tsang [1 ,2 ]
Huang, Chun-I [2 ,3 ]
Lee, Chen-Hsen [1 ,2 ,3 ]
Tang, Gau-Jun [1 ,4 ]
机构
[1] Natl Yang Ming Univ, Sch Med, Inst Emergency & Crit Care Med, Taipei 112, Taiwan
[2] Taipei Vet Gen Hosp, Emergency Dept, Taipei 112, Taiwan
[3] Natl Yang Ming Univ, Sch Med, Dept Emergency Med, Taipei 112, Taiwan
[4] Natl Yang Ming Univ Hosp, Emergency Dept, Ilan 260, Taiwan
关键词
SEPTIC SHOCK; INFLAMMATION; PATHOGENS; PROGNOSIS; PATTERNS; TREM-1; CAP;
D O I
10.1016/j.ajem.2010.01.010
中图分类号
R4 [临床医学];
学科分类号
100218 [急诊医学];
摘要
Objectives: The purpose of this study is to investigate the clinical use of inflammatory marker triggering receptor expressed on myeloid cells (TREM)-1 at admission for differentiating between typical and atypical bacterial community-acquired pneumonia (CAP). Methods: A prospective, noninterventional study of patients with CAP hospitalized through the emergency department was performed. Surface expression of TREM-1 was analyzed using flow cytometry on peripheral blood cells, and soluble TREM-1 (sTREM-1) concentration was determined in plasma. Results: Eighty-eight patients with clinical suspicion of CAP were eligible. The causative pathogen was identified in 39 patients (44.3%). After excluding 4 mixed pneumonia cases, 21 typical and 14 atypical bacterial infections were enrolled. Patients with typical bacterial CAP demonstrated increased TREM-1 surface expression on monocytes and neutrophils. Median plasma sTREM-1 levels at admission were 65.2 pg/mL (range, 17.6-138.1 pg/mL) in patients with typical CAP and 25.9 pg/mL (range, 11.5-54.8 pg/mL) in patients with atypical CAP (P < .001). Soluble TREM-1 had good discriminative value to differentiate typical from atypical pathogens with an area under the receiver operating characteristic curve of 0.87(95% confidence interval, 0.75-0.98). At a cutoff level of 44.2 pg/mL, sTREM-1 yielded a sensitivity of 81%, a specificity of 79%, a positive likelihood ratio of 3.79, and a negative likelihood ratio of 0.24. Conclusions: In newly admitted patients with CAP, determination of the TREM-1 levels may provide useful additional diagnostic information on the bacterial etiology. (C) 2011 Elsevier Inc. All rights reserved.
引用
收藏
页码:626 / 631
页数:6
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