06 ng/mL, 2.38 mg/L, and 129 pg/mL for the prediction of 6-month mortality ( Table 2). Using the upper limit of normal of 0.5 ng/mL for PCT and 5 mg/L for CRP, the sensitivity was 41.0% and 69.2%, and the specificity was 94.5% and 62.0%, respectively. Higher PCT, CRP, and sTREM-1 levels as well as age, a lower albumin level, and the presence of cavitary lesion and pleural effusion were associated with 6-month mortality in the univariate Cox proportional hazards model (Table 3). In multivariate regression analysis, only PCT, sTREM-1, and albumin levels remained independently associated

with 6-month mortality. With a cutoff of 0.5 ng/mL serum PF-01367338 ic50 PCT, patients with ≧0.5 ng/mL had significantly shorter survival than those with <0.5 ng/mL (Fig. 3A). Similarly, patients

with a serum sTREM-1 level of 129 pg/mL or above had significantly poor prognosis (Fig. 3B). Table 4 shows the characteristics of patients with dichotomous levels of PCT (≧0.5 vs. <0.5 ng/mL) and sTREM-1 (≧129 vs. <129 pg/mL). Patients with PCT ≧0.5 ng/mL or sTREM-1 ≧129 pg/mL were more likely to have disseminated TB and to die within 2 or 6 months. Table 5 shows the dichotomous levels of PCT and sTREM-1 in each cause of death. Because of limited patient number, only patients succumbed to multi-organ failure and progressive respiratory failure could be analyzed. selleck chemicals llc We observed that sTREM-1 ≧129 pg/mL seemed to be better at predicting mortality due to multi-organ failure than PCT ≧0.5 ng/mL. In this prospective study of 243 patients diagnosed with PTB, we compared the potential of serum PCT, CRP, and sTREM-1

Vorinostat ic50 levels to predict an unfavorable outcome for PTB patients. We report five major findings. First, a significant proportion of patients with PTB had serum CRP levels above the normal cutoff; however, serum levels of PCT above the upper limit of normal were observed in only few PTB patients. Second, PCT, CRP, and sTREM-1 levels on the diagnosis of PTB were significantly higher in 6-month nonsurvivors than in survivors. Third, PCT, CRP, and sTREM-1 exhibited comparable discriminative power in predicting 6-month mortality in patients with PTB. Fourth, higher PCT and sTREM-1 levels and a lower albumin level were independent associated with a poor 6-month outcome. Fifth, a PCT level over the normal cutoff (0.5 ng/mL) and an sTREM-1 level above the best cutoff (129 pg/mL) were also associated with higher 2-month mortality and the presence of disseminated TB. It has been reported that sTREM-1 is poorly expressed in pneumonia or pleuritis caused by TB compared with in those caused by bacteria.8, 13, 14 and 18 Although the reasons why the TREM-1 response in TB is poor remain to be clarified, there are two possible explanations. One is that TREM-1 expression is strongly upregulated by extracellular bacteria; in contrast, intracellular microorganisms, such as MTB, have no effect.