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

Chorng Kuang How, Sen Kuang Hou, Hsin Chin Shih, David Hung Tsang Yen, Chun I. Huang, Chen Hsen Lee, Gau Jun Tang

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)626-631
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume29
Issue number6
DOIs
Publication statusPublished - Jul 1 2011
Externally publishedYes

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Myeloid Cells
Pneumonia
Bacterial Infections
ROC Curve
Hospital Emergency Service
Monocytes
Blood Cells
Flow Cytometry
Neutrophils
Prospective Studies
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia. / How, Chorng Kuang; Hou, Sen Kuang; Shih, Hsin Chin; Yen, David Hung Tsang; Huang, Chun I.; Lee, Chen Hsen; Tang, Gau Jun.

In: American Journal of Emergency Medicine, Vol. 29, No. 6, 01.07.2011, p. 626-631.

Research output: Contribution to journalArticle

How, Chorng Kuang ; Hou, Sen Kuang ; Shih, Hsin Chin ; Yen, David Hung Tsang ; Huang, Chun I. ; Lee, Chen Hsen ; Tang, Gau Jun. / Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia. In: American Journal of Emergency Medicine. 2011 ; Vol. 29, No. 6. pp. 626-631.
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abstract = "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.",
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