Usefulness of Triggering Receptor Expressed on Myeloid Cell-1 in Differentiating between Typical and Atypical Community-Acquired Pneumonia

• Main Authors: Sen-Kuang Hou, 侯甚光
• Other Authors: David Hung-Tsang Yen
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/65164378127610527452

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.