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Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for distinguishing bacterial (Empyema) from non-bacterial pleural effusion

Abstract number: P1404

Shaked H., Yuhas Y., Ashkenazi S., Goldberg E., Bishara J.

Objectives: Exudative effusion is a common clinical condition among hospitalised patients which might be secondary to infection, malignancy, lymphatic abnormalities, and non-infectious inflammation. Biochemical parameters used nowadays to distinguish bacterial from non-bacterial pleural effusion before the results of pleural fluid cultures are available, have wide zones of overlap between the different causes of exudative effusion. A rapid microbiologic tool is the Gram stain but its sensitivity is low, approximately 50%. Triggering receptor expressed on myeloid cells (TREM)-1 is a recently identified molecule that is involved in monocytic activation and in the inflammatory response. Studies have shown that TREM-1 is up regulated by microbial products in the plasma, bronchoalveolar lavage fluid, and cerebrospinal fluid of patients with sepsis, pneumonia and bacterial meningitis, respectively.

Two recent studies showed that the soluble TREM-1 (sTREM-1) levels were significantly higher in infectious pleural effusions compare to pleural effusion of other aetiology. However, in those studies sTREM-1 levels in definite empyema versus exudative pleural effusion due to other inflammatory processes, such as Dressler's syndrome were not evaluated. We aimed to evaluate whether sTREM-1 in exudative pleural effusion can predict a bacterial infection (pleural empyema).

Methods: Patients of all ages who present with pleural effusion were identified through laboratory records. In addition to routine biochemical markers, differential white blood cells, cytology, Gram stain and pleural fluid culture, pleural fluid sTREM-1 was measured by ELISA using a commercial kit (R&D Systems Minneapolis, USA). Empyema was defined as aspiration of pus, a positive Gram stain or culture results, pH < 7.2, a glucose level <40 mg/dl, and an LDH > 1000 IU/L.

Results: Thirty-eight patients were included in the study. Seven patients had empyema, 3 – simple parapnomonic effusion, 8 – transudate, 5 – Dressler's syndrome, 8 – malignancy, 1 – connective tissue disease, and 6 patients had undetermined effusion. Mean levels of sTREM-1 were significantly higher in empyema (614 ± 184 pg/ml) compared with the other effusions (61 ± 42 pg/ml, p =0.03).

Conclusions: Our findings suggest that sTREM-1 is up-regulated in the pleural effusion of patients with empyema and can potentially assist clinicians in early early differentiation of bacterial.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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