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Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during ventilator-associated pneumonia

Introduction

The diagnosis of ventilator-associated pneumonia (VAP) remains a clinical challenge. Biological markers may facilitate the diagnosis of VAP. The triggering receptor expressed on myeloid cells (TREM-1) is a member of the immunoglobulin superfamily and is upregulated on phagocytes in the presence of bacterial products. Soluble (s) TREM-1 in bronchoalveolar-lavage fluid has been shown to be a promising biological marker for pneumonia. In the present study we performed serial measurements of sTREM-1 in lungs and plasma of patients who were at risk of developing VAP.

Methods

In a single-centre prospective study, a non-directed bronchial lavage (NBL) was performed on alternate days in patients expected to require mechanical ventilation for > 5 days. A total of 28 patients were studied, nine of whom developed VAP. Diagnosis of pneumonia required a combination of clinical features plus microbiological confirmation. Levels of sTREM-1 were measured in NBL fluid (NBLF) and matching plasma samples by ELISA. Data are presented as medians (± IQR). Changes over time were tested within each group separately using analysis of repeated measures (linear mixed models). The P value in Fig. 1 denotes statistical significance.

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Figure 1

Results

Levels of sTREM-1 in NBLF (upper graphs) and plasma (lower graphs) of patients without VAP (left graphs) and of patients developing VAP (right graphs). In the first patient group 'day 0' represents the day at which mechanical ventilation was initiated, in the latter group 'day 0' denotes the day at which the diagnosis of VAP was made clinically. The P value indicates statistical significance of rise of local sTREM-1 levels.

Conclusion

NBLF sTREM-1 levels significantly rise in ventilated patients developing VAP. These results further confirm the usefulness of sTREM-1 as a biological marker for VAP.

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Determann, R., Millo, J., Gibot, S. et al. Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during ventilator-associated pneumonia. Crit Care 9, P175 (2005). https://doi.org/10.1186/cc3238

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Keywords

  • Pneumonia
  • Mechanical Ventilation
  • Linear Mixed Model
  • Myeloid Cell
  • Biological Marker