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.

Tytuł:: 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.
Autorzy:: 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.
Źródło:: Critical care medicine [Crit Care Med] 2021 Oct 01; Vol. 49 (10), pp. 1664-1673.
Typ publikacji:: Journal Article; Observational Study
Język:: English
Imprint Name(s):: Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.
MeSH Terms:: Bacterial Infections/*diagnosis
RNA, Messenger/*analysis
Virus Diseases/*diagnosis
Aged ; Aged, 80 and over ; Area Under Curve ; Bacterial Infections/blood ; Bacterial Infections/physiopathology ; Berlin ; Biomarkers/analysis ; Biomarkers/blood ; Emergency Service, Hospital/organization & administration ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; RNA, Messenger/blood ; ROC Curve ; Virus Diseases/blood ; Virus Diseases/physiopathology
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Substance Nomenclature:: 0 (Biomarkers)
0 (RNA, Messenger)
Entry Date(s):: Date Created: 20210624 Date Completed: 20211004 Latest Revision: 20230812
Update Code:: 20240105
PubMed Central ID:: PMC8439671
DOI:: 10.1097/CCM.0000000000005119
PMID:: 34166284
: Czasopismo naukowe

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.
(Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)

Comment in: Crit Care Med. 2021 Oct 1;49(10):1812-1814. (PMID: 34529611)

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