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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2731v1 132/1/58    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Horonenko, G. Articles by Hayden, J. M. Search for Related Content PubMed PubMed Citation Articles by Horonenko, G. Articles by Hayden, J. M.

Soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) is increased in patients with ventilator-associated pneumonia: a preliminary report

Carl T. Hayden VA Medical Center, Good Samaritan Regional Medical Center and the Arizona Respiratory Center, Phoenix, AZ

Richard.Robbins2{at}med.va.gov

Richard.Robbins2{at}med.va.gov

Abstract

RationaleThe diagnosis of ventilator-associated pneumonia can be difficult. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has been reported to be elevated in bronchoalveolar lavage fluid from patients with ventilator-associated pneumonia (VAP). Objectives: To evaluate the utility sTREM-1 in the diagnosis of ventilator-associated pneumonia in bronchoalveolar lavage fluid and the fluid collected in the expiratory trap from the ventilator, exhaled ventilator condensate (EVC). Methods: We prospectively collected bronchoalveolar lavage fluid and EVC from 23 patients clinically suspected of VAP. A sensitive enzyme-linked immunosorbant assay was developed to measure sTREM-1. The results derived from this assay were confirmed using an immunoblot technique. The presence of VAP was clinically determined using the modified clinical pulmonary infection score of > 6. Results: Fourteen of 23 patients were diagnosed with VAP. sTREM-1 was detected in the EVC in 11 of 14 subjects with VAP but in only 1 of 9 subjects without ventilator-associated pneumonia and was significantly higher in the pneumonia patients and when expressed as pg/ml or pg/µg protein (p=0.005, both comparisons). In contrast, sTREM was detected in the bronchoalveolar lavage fluid of all 14 VAP subjects but also in of 8 of 9 subjects with no pneumonia and did not differ in the VAP subjects compared to the non-pneumonia subjects when expressed as pg/ml or pg/µg protein (p>0.05 both comparisons ). Conclusion: sTREM-1 is detectable in EVC and may be useful in establishing or excluding the diagnosis of VAP.

Key Words: ventilator-associated pneumonia • exhaled breath condensate • soluble triggering receptor expressed on myeloid cells-1 • bronchoalveolar lavage