الفهرس 
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Abstract
This study was done to evaluate the value and significance of sTREM -1 assesment in the diagnosis of pleural effusion aetiology caused by different diseases entities. It was conducted in El Mehala Chest Hospital and it included 80 patients with pleural effusions of different etiologies. These patients were classified into 4 groups:
Group1: twenty patients with transudative pleural effusion, 5 of them the aetiology of effusion was cardiac, 10 was hepatic and 5 was renal. Their ages ranged from 48 to 70 years with a mean age of 58 ± 6.26 years. Group2: 20 patients with malignant pleural effusion. Their ages ranged from 40 to 66 years, with a mean age of 54.05 ± 7.65 years .
Group3: 20 patients with tuberculous pleural effusion. Their ages ranged from 43 to 64 years, with a mean age of 53.50±6.21 years.
Group4: 20 patients with para-pneumonic pleural effusion. Their ages ranged from 38 to 64 years, with a mean age of 52.50±6.95 years.
Patients were subjected to:-
1. Full clinical history and clinical examination.
2. Routine laboratory investigations. e.g: complete blood picture, erethrocyte sedimentation rate (ESR), blood urea and serum creatinine, Fasting and post prandial blood sugar and liver function tests especially albumin.
3. Radiological examination:-
Plain chest X ray postero-anterior and lateral views.
Whenever needed the following was done:
Computed tomography (CT) scan of the chest.
Abdominal ultrasongraphy.
Echocardiography.
4. Tuberculin skin test.
5. Sputum examination for acid fast bacilli (AFB) by Ziehl Neelsen stain, on 3 successive days.
6. Serum protein and LDH.
7. Diagnostic thoracocentesis:
Collection and processing of the pleural fluid samples. The pleural fluid obtained was subjected to the following :
a. Physical examination including (aspect, colour, odour, specific gravity).
b. Chemical examination including:
Protein level, glucose level and adenosine deaminase level, when tuberculous effusion is suspected and lactic dehydrogenase level
c. Bacteriological examination.
d. Cytological examination differential leucocytic count and cytological examination for malignant cells.
e. Assessment of the level of soluble triggering receptor expressed on myeloid cells-1(TREM-1) by Enzyme Linked Immunosorbent Assay (ELIZA).
The present work revealed that:-
The mean value of pleural fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level was 6.75±3.35 in transudative effusion, 15.37±5.01 in malignant effusions , 34.90±10.51 in tuberculous effusions and 45.50±13.21 in parapneumonic effusions . The statistical comparison showed that there were significant differences on comparing the mean values of sTREM-1 in transudateive, malignant, tuberculous and para-pneumonic effusions with each other.
Pleural fluid sTREM -1 level was significantly higher in patients with parapneumonic effusion as compared with tuberculous, malignant and transudative effusions. In tuberculous effusion sTREM-1 level was significantly high as compared with malignant effusions and transudative effusions. In malignant effusion sTREM-1 level was significantly high as compared with transudative effusions.
There was positive correlation between soluble triggering receptor expressed on myeloid cells -1(sTREM-1) and LDH and protein in pleural fluid in transudative, malignant, tuberculous and para-pneumonic effusions.
There was negative correlation between soluble triggering receptor expressed on myeloid cells -1(sTREM-1) and age.
Receiver-operating characteristic (ROC) curve analysis showed that pleural fluid sTREM-1 had a sensitivity of 100.0% and a specificity of 87 % for differentiation infectious and non infectious pleural effusion at an optimal cutoff value 13.75 ng/L. The area under the ROC curve (AUC) was 0.97.