| Summary: | 碩士 === 國立陽明大學 === 急重症醫學研究所 === 98 === Objectives：To investigate the clinical utility 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, non-interventional 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：88 patients with clinical suspicion of CAP were eligible. The causative pathogen was identified in 39 patients (44.3%). After excluding four mixed pneumonia, 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 to 138.1 pg/ml) in patients with typical CAP and 25.9 pg/mL (range, 11.5 to 54.8 pg/mL) in patients with atypical CAP (P < 0.001). sTREM-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 levels 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.
Key Words：atypical pneumonia; biological marker; community-acquired pneumonia; diagnosis; triggering receptors expressed on myeloid cells (TREM)-1.
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