• Jin Won Huh, Chae-Man Lim, Younsuck Koh, Yeon Mok Oh, Tae Sun Shim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, and Sang-Bum Hong.
• Department of Pulmonary and Critical Care Medicine, Ilsan Paik Hospital, Inje University, 2240, Daehwa-dong, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 411-706, Korea.
• Crit Care. 2008 Jan 1;12(1):R6.

BackgroundDifferential diagnosis of patients with bilateral lung infiltrates remains a difficult problem for intensive care clinicians. Here we evaluate the diagnostic role of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in bronchoalveolar lavage (BAL) specimens from patients with bilateral lung infiltrates.MethodsWe conducted a prospective observational study on 80 patients with bilateral lung infiltrates with clinical suspicion of infectious pneumonia. Patients were categorized into three groups: bacterial or fungal infection, intracellular or viral infection, and noninfectious inflammatory disease. sTREM-1 concentrations were measured, and BAL fluid and Clinical Pulmonary Infection Score (CPIS) were analyzed.ResultsThe sTREM-1 concentration was significantly increased in patients with bacterial or fungal pneumonia (n = 29, 521.2 +/- 94.7 pg/ml), compared with that in patients with viral pneumonia, atypical pneumonia or tuberculosis (n = 14, 92.9 +/- 20.0 pg/ml) or noninfectious inflammatory disease (n = 37, 92.8 +/- 10.7 pg/ml). The concentration of sTREM-1 in BAL fluid, but not CPIS, was an independent predictor of bacterial or fungal pneumonia, and a cutoff value of more than 184 pg/ml yielded a diagnostic sensitivity of 86% and a specificity of 90%.ConclusionThe sTREM-1 level in BAL fluid from patients with bilateral lung infiltrates is a potential marker for the differential diagnosis of pneumonia due to extracellular bacteria.

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