Decoding the Diagnostic Puzzle: Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) as a Biomarker in Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) poses a considerable challenge in intensive care units (ICUs), causing significant morbidity and mortality (1). Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) has shown promising potential as a diagnostic biomarker for VAP (2). This comprehensive review examines the progress, sensitivity, and specificity of sTREM-1 as a VAP biomarker, with a thorough analysis of recent research in the field. Ventilator-associated pneumonia is a significant problem in the ICU, carrying high morbidity and mortality rates (1). The discovery of sTREM-1 as a promising biomarker for VAP diagnosis has brought a significant paradigm shift in this scenario (2).

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Elevated levels of sTREM-1 in bronchoalveolar lavage fluid and serum of patients with VAP have been demonstrated, indicating its potential diagnostic value (3). Although there are variations in sensitivity and specificity across studies, the results are promising (4). sTREM-1 may not offer definitive diagnosis as a standalone marker but can potentially enhance diagnostic accuracy when combined with clinical criteria and other biomarkers (5). The role of sTREM-1 as a prognostic indicator is also under exploration, potentially predicting outcomes and monitoring treatment response (6). Given the increasing resistance to antibiotics and the high mortality rate associated with VAP, the use of a biomarker like sTREM-1 that can provide an early and accurate diagnosis is a significant advance (7). Despite the encouraging data, more research is needed to establish the ideal cutoff levels for sTREM-1 in different populations and to understand the factors that might affect its levels in critically ill patients (8).

?Conclusion:sTREM-1 is a promising diagnostic biomarker for VAP. The integration of this biomarker into routine clinical practice could enhance diagnostic accuracy, guide therapeutic strategies, and improve patient outcomes (9). However, further large-scale studies are needed to confirm these findings and to refine the clinical utility of sTREM-1 in VAP (10).

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References:

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1. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184-93.

2. Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004;350(5):451-8.

3. Porfyridis I, Plachouras D, Karagianni V, Kotanidou A, Papiris SA, Giamarellou H, et al. Diagnostic value of triggering receptor expressed on myeloid cells-1 and C-reactive protein for patients with lung infiltrates: an observational study. BMC Infect Dis. 2010;10:286.

4. Palazzo SJ, Simpson TA, Simmons JM, Schnapp LM. Soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) as a Diagnostic Marker of Ventilator-associated Pneumonia. Respir Care. 2012;57(12):2052-8.

5. Su LX, Feng L, Zhang J, Xiao YH, Jia YH, Yan P, et al. Diagnostic value of urine sTREM-1 for sepsis and relevant acute kidney injuries: a prospective study. Crit Care. 2011;15(5):R250.

6. El Solh AA, Akinnusi ME, Peter M, Berim I, Schultz MJ, Pineda L. Triggering receptors expressed on myeloid cells in pulmonary aspiration syndromes. Intensive Care Med. 2008;34(6):1012-9.

7. Kollef MH. Broad-spectrum antimicrobials and the treatment of serious bacterial infections: getting it right up front. Clin Infect Dis. 2008;47(Supplement_1):S3-13.

8. Adib-Conquy M, Monchi M, Goulenok C, Laurent I, Thuong M, Cavaillon JM, et al. Increased plasma levels of soluble triggering receptor expressed on myeloid cells 1 and procalcitonin after cardiac surgery and cardiac arrest without infection. Shock. 2007;28(4):406-10.

9. Anand NJ, Zuick S, Klesney-Tait J, Kollef MH. Diagnostic implications of soluble triggering receptor expressed on myeloid cells-1 in BAL fluid of patients with pulmonary infiltrates in the ICU. Chest. 2009;135(3):641-7.

10. Bouchon A, Facchetti F, Weigand MA, Colonna M. TREM-1 amplifies inflammation and is a crucial mediator of septic shock. Nature. 2001;410(6832):1103-7.

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