Diagnostic value of triggering receptor expressed on myeloid cells-1 and C-reactive protein for patients with lung infiltrates: an observational study

Abstract

BackgroundDifferential diagnosis of patients with lung infiltrates remains a challenge. Triggering receptor expressed on myeloid cells (TREM)-1 is a neutrophil and monocyte receptor up-regulated during infection. The aim of this study was to evaluate the diagnostic accuracy of TREM-1 and of C-reactive protein (CRP) from patients with lung infiltrates to discern community acquired lung infections.Methods68 patients admitted to a medical ward with acute respiratory illness were enrolled in the study. Neutrophil and monocyte TREM-1 expression were measured by flow cytometry, sTREM-1 by an enzyme immunoassay and C-reactive protein by nephelometry. Clinical pulmonary infection score was recorded.Results34 patients were diagnosed with bacterial community acquired pneumonia (group A) and 34 with non-bacterial pulmonary disease (group B). Median serum TREM-1 concentration was 102.09 pg/ml in group A and lower than 15.10 pg/ml (p < 0.0001) in group B. Mean±SE neutrophil TREM-1 expression was 4.67 ± 0.53 MFI in group A and 2.64 ± 0.25 MFI (p = 0.001) in group B. Monocyte TREM-1 expression was 4.2 ± 0.42 MFI in group A and 2.64 ± 0.35 MFI (p = 0.007) in group B and mean±SE CRP was 18.03 ± 2 mg/ml in group A and 7.1 ± 1.54 mg/ml (p < 0.001) in group B. A cut-off of 19.53 pg/ml of sTREM-1 with sensitivity 82.6% and specificity 63% to discriminate between infectious and non-infectious pulmonary infiltrates was found. sTREM-1 at admission greater than 180 pg/ml was accompanied with unfavourable outcome.ConclusionTREM-1 myeloid expression and sTREM-1 are reliable markers of bacterial infection among patients with pulmonary infiltrates; sTREM-1 is a predictor of final outcome.

C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia

“…A threshold procalcitonin value of 1.1 ng/mL achieved a sensitivity of 80% and a specificity of 82% in predicting in-patient mortality. A survival analysis using Kaplan-Meier curves and the log-rank test demonstrated that procalcitonin serum levels upon admission of Ͻ 1.1 ng/mL were associated with better survival (log- Congestive heart failure (26) Congestive heart failure (15) Chronic respiratory diseases (9) Chronic respiratory diseases (18) Chronic renal failure (6) Chronic renal failure (6) Psychiatric disease (10) Cognitive impairment (10) Cognitive impairment (41) Gastrostomy (4) Tracheostomy (3) Diagnoses (n) NHAP (58) Lung cancer (3) Streptococcus pneumoniae (8) Pulmonary embolism (4) Staphylococcus aureus (4) Congestive heart failure (7) Haemophilus influenzae (4) Bronchial asthma exacerbation (2) Pseudomonas aeruginosa (5) COPD exacerbation (10 rank test, P Ͻ .001) (Fig. 5).…”

“…Previous studies showed that CPIS was useful in the diagnosis of CAP and VAP. 6,7 The assessment of CPIS is simple, calculating 6 variables (tracheal secretions, chest x-ray findings, temperature, WBC, P aO 2 /F IO 2 ratio, and microbiology). Tracheal secretions can be obtained via suction from subjects having difficulty secreting their sputum.…”

“…2 C-reactive protein and procalcitonin have been described as reliable markers for the diagnosis and prognosis of CAP and VAP with contradictory results, especially for VAP. [3][4][5][6][24][25][26][27][28][29][30] According to American Thoracic Society/Infectious Diseases Society of America guidelines, NHAP is considered to be a distinct group of respiratory infections with more similarities with hospital acquired pneumonia and VAP than with CAP. 15 However, there are only limited data in the literature on the role of biomarkers in NHAP.…”

“…Clinical, laboratory, and imaging data were recorded immediately after admission for each subject, including (1) past medical history and clinical presentation, (2) prior use of antibiotics and/or steroids, (3) body temperature, (4) arterial blood gases, (5) peripheral blood cell counts, (6) Gram stains and cultures of all biological fluids obtained (blood, sputum, bronchial secretions, bronchoalveolar lavage, and pleural fluid), (7) imaging findings, and (8) antigen serology (Legionella pneumophila and Streptococcus pneumonia urinary antigen). The functional status of each subject before admission was assessed according to the Eastern Cooperative Oncology Group score, 13 which runs from 0 to 5, with 0 denoting perfect health and 5 indicating death.…”

“…2 Many biomarkers, such as leukocyte count, C-reactive protein, and procalcitonin, have been found to play a role in the early diagnosis and prognosis of pneumonia, especially CAP and ventilator-associated pneumonia (VAP). [3][4][5][6] In addition, clinical infection scores, such as the clinical pulmonary infection score (CPIS), have been evaluated in the early diagnosis of VAP and CAP 6,7 However, there are only limited data on NHAP.…”