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A Novel 29-Messenger RNA Host-Response Assay From Whole Blood Accurately Identifies Bacterial and Viral Infections in Patients Presenting to the Emergency Department With Suspected Infections: A Prospective Observational Study.
Bauer, Wolfgang; Kappert, Kai; Galtung, Noa; Lehmann, Dana; Wacker, James; Cheng, Henry K; Liesenfeld, Oliver; Buturovic, Ljubomir; Luethy, Roland; Sweeney, Timothy E; Tauber, Rudolf; Somasundaram, Rajan.
  • Bauer W; Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
  • Kappert K; Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany.
  • Galtung N; Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
  • Lehmann D; Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
  • Wacker J; Inflammatix, Burlingame, CA.
  • Cheng HK; Inflammatix, Burlingame, CA.
  • Liesenfeld O; Inflammatix, Burlingame, CA.
  • Buturovic L; Inflammatix, Burlingame, CA.
  • Luethy R; Inflammatix, Burlingame, CA.
  • Sweeney TE; Inflammatix, Burlingame, CA.
  • Tauber R; Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany.
  • Somasundaram R; Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
Crit Care Med ; 49(10): 1664-1673, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1452743
ABSTRACT

OBJECTIVES:

The rapid diagnosis of acute infections and sepsis remains a serious challenge. As a result of limitations in current diagnostics, guidelines recommend early antimicrobials for suspected sepsis patients to improve outcomes at a cost to antimicrobial stewardship. We aimed to develop and prospectively validate a new, 29-messenger RNA blood-based host-response classifier Inflammatix Bacterial Viral Non-Infected version 2 (IMX-BVN-2) to determine the likelihood of bacterial and viral infections.

DESIGN:

Prospective observational study.

SETTING:

Emergency Department, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany. PATIENTS Three hundred twelve adult patients presenting to the emergency department with suspected acute infections or sepsis with at least one vital sign change.

INTERVENTIONS:

None (observational study only). MEASUREMENTS AND MAIN

RESULTS:

Gene expression levels from extracted whole blood RNA was quantified on a NanoString nCounter SPRINT (NanoString Technologies, Seattle, WA). Two predicted probability scores for the presence of bacterial and viral infection were calculated using the IMX-BVN-2 neural network classifier, which was trained on an independent development set. The IMX-BVN-2 bacterial score showed an area under the receiver operating curve for adjudicated bacterial versus ruled out bacterial infection of 0.90 (95% CI, 0.85-0.95) compared with 0.89 (95% CI, 0.84-0.94) for procalcitonin with procalcitonin being used in the adjudication. The IMX-BVN-2 viral score area under the receiver operating curve for adjudicated versus ruled out viral infection was 0.83 (95% CI, 0.77-0.89).

CONCLUSIONS:

IMX-BVN-2 demonstrated accuracy for detecting both viral infections and bacterial infections. This shows the potential of host-response tests as a novel and practical approach for determining the causes of infections, which could improve patient outcomes while upholding antimicrobial stewardship.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Bacterial Infections / Virus Diseases / RNA, Messenger Subject: Bacterial Infections / Virus Diseases / RNA, Messenger Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Crit Care Med Clinical aspect: Diagnosis / Prediction / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Bacterial Infections / Virus Diseases / RNA, Messenger Subject: Bacterial Infections / Virus Diseases / RNA, Messenger Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Crit Care Med Clinical aspect: Diagnosis / Prediction / Prognosis Year: 2021
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