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The aim of this study was to investigate the time course, and correlation with prognosis, of BAL fluid concentrations of soluble triggering receptor expressed on myeloid cells (sTREM-1) in patients with ventilator-associated pneumonia (VAP).The study included 35 patients with clinically diagnosed VAP, eight of whom were BAL fluid culture-negative and 27 BAL fluid culture-positive (16 survivors, 11 non-survivors). sTREM-1 levels were measured in BAL fluid of these mechanically ventilated patients, at the time of diagnosis, on days 4–5 and on days 7–9. The time course of this biomarker and its prognostic value for outcome in patients with culture-positive VAP were assessed.sTREM-1 concentrations were significantly greater in culture-positive VAP patients than in culture-negative VAP patients. sTREM-1 levels decreased significantly with time in surviving patients with culture-positive VAP, but increased significantly with time in non-survivors. In contrast, PaO2/fraction of inspired oxygen (FiO2) increased significantly with time in survivors and decreased significantly with time in non-survivors. At a cut-off value of −10 pg/mL 7–9 days after initial diagnosis, sTREM levels had a sensitivity of 90% and a specificity of 87.5% for predicting mortality.sTREM-1 concentrations in BAL fluid are of potential prognostic value in patients with VAP.BAL fluid sTREM-1 levels were measured in mechanically ventilated patients with or without culture-positive ventilator-associated pneumonia (VAP). sTREM-1 concentrations were significantly higher in culture-positive VAP patients, and among these patients, sTREM-1 levels decreased significantly with time in survivors, but increased significantly with time in non-survivors.These authors contributed equally to this paper.