Infectious pleural effusions can be identified by sTREM-1 levels

SummaryBackground and objectiveConventional methods to establish pleural infection are time-consuming and sometimes inadequate. Biomarkers may aid in making rapid diagnosis of infection. In an observational study we evaluated and compared the diagnostic value of pleural fluid levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein and procalcitonin in intensive care patients with pleural effusions.MethodsThirty-six patients with de novo pleural effusions were included and 20 patients with pleural effusions after cardiothoracic surgery and 20 patients with pleural effusions after esophagus surgery acted as controls. Levels of sTREM-1, C-reactive protein and procalcitonin were measured in pleural effusions.ResultsLevels of sTREM-1 were highest in empyemas, followed by infectious exudates. Levels of sTREM-1 were low in transudates and non-infectious exudates. C-reactive protein levels were highest in exudates and empyemas, while procalcitonin levels were highest in exudates. Pleural fluid with positive culture results contained higher sTREM-1 and C-reactive protein levels as compared to samples with negative culture results. A cut-off level of 50pg/mlsTREM-1 yielded a sensitivity of 93% and a specificity of 86%, while these were 87% and 67% respectively for a cut-off value of 7.5μg/ml C-reactive protein, and 60% and 64% respectively for a cut-off value of 0.15 ng/ml procalcitonin.ConclusionsTREM-1 is superior to C-reactive protein and procalcitonin in detecting infection

Obesity, obstructive sleep apnea, and cardiovascular risk

Obesity is a major risk factor for cardiovascular disease, the number one killer of Americans. It is also a major risk factor for obstructive sleep apnea, which is rising in the US population as the obesity epidemic continues. Obstructive sleep apnea, in turn, has been implicated as a risk factor for hypertension, glucose dysregulation, and cardiovascular disease. Understanding the pathophysiologic links and the common-soil hypothesis for these rapidly growing disorders is of paramount importance for developing strategic therapeutic and preventive plans. This article discusses the associations of obesity, obstructive sleep apnea, and cardiovascular disease, highlighting the pathophysiologic mechanisms, including increased oxidative stress, endothelial dysfunction, and inflammation