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Zhou X, Liu C, Xu Z, Song J, Jin H, Wu H, Cheng Q, Deng W, He D, Yang J, Lin J, Wang L, Wang Z, Chen C, Weng J. Combining host immune response biomarkers and clinical scores for early prediction of sepsis in infection patients. Ann Med 2024; 56:2396569. [PMID: 39212218 PMCID: PMC11370677 DOI: 10.1080/07853890.2024.2396569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/12/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The performance of host immune responses biomarkers and clinical scores was compared to identify infection patient populations at risk of progression to sepsis, ICU admission and mortality. METHODS Immune response biomarkers were measured and NEWS, SIRS, and MEWS. Logistic and Cox regression models were employed to evaluate the strength of association. RESULTS IL-10 and NEWS had the strongest association with sepsis development, whereas IL-6 and CRP had the strongest association with ICU admission and in-hospital mortality. IL-6 [HR (95%CI) = 2.68 (1.61-4.46)] was associated with 28-day mortality. Patient subgroups with high IL-10 (≥ 5.03 pg/ml) and high NEWS (> 5 points) values had significantly higher rates of sepsis development (88.3% vs 61.1%; p < 0.001), in-hospital mortality (35.0% vs. 16.7%; p < 0.001), 28-day mortality (25.0% vs. 5.6%; p < 0.001), and ICU admission (66.7% vs. 38.9%; p < 0.001). CONCLUSIONS Patients exhibiting low severity signs of infection but high IL-10 levels showed an elevated probability of developing sepsis. Combining IL-10 with the NEWS score provides a reliable tool for predicting the progression from infection to sepsis at an early stage. Utilizing IL-6 in the emergency room can help identify patients with low NEWS or SIRS scores.
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Affiliation(s)
- Xiaoming Zhou
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Precision General Practice and Health Management, Wenzhou, China
| | - Chen Liu
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Geriatric Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhe Xu
- Department of Intensive Care Unit, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiaze Song
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Haijuan Jin
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Theorem Clinical College of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou, China
| | - Hao Wu
- Taishun County People’s Hospital Medical Community Sixi Branch, Taishun, China
| | - Qianhui Cheng
- Department of Geriatric Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wenqian Deng
- Department of Geriatric Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dongyuan He
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Jingwen Yang
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of General Practice, Taizhou Women and Children’s Hospital of Wenzhou Medical University, Taizhou, China
| | - Jiaying Lin
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of General Practice, Taizhou Women and Children’s Hospital of Wenzhou Medical University, Taizhou, China
| | - Liang Wang
- Department of Public Health, Robbins College of health and Human Sciences, Baylor University, Waco, TX, USA
| | - Zhiyi Wang
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Precision General Practice and Health Management, Wenzhou, China
- Theorem Clinical College of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou, China
- South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou, China
| | - Chan Chen
- Wenzhou Key Laboratory of Precision General Practice and Health Management, Wenzhou, China
- Department of Geriatric Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jie Weng
- Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Precision General Practice and Health Management, Wenzhou, China
- South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou, China
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Hu D, Yao Q. Using blood TNF-related apoptosis-inducing ligand levels to discriminate between viral and bacterial infections: A prospective observational study. Diagn Microbiol Infect Dis 2024; 110:116443. [PMID: 39032319 DOI: 10.1016/j.diagmicrobio.2024.116443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/10/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE The aim of the investigation was to evaluate variations in blood TNF-related apoptosis-inducing ligand (TRAIL) levels between patients with viral and bacterial infections and the diagnostic performance of TRAIL for identifying viral and bacterial infections. METHODS The investigation included 169 adult (>18 years) patients presenting with medical signs of acute infections (inclusion criteria included a body temperature over 37.5 °C, an onset of symptoms no more than 12 days). Reference standard was based on a rigorous expert panel and the majority of the panel determined the infectious etiology. Finally, 104 patients with 78 bacterial and 26 viral reference standard outcomes were enrolled in this investigation (24 were eliminated depending on the exclusion criteria; 41 had indeterminate reference standard diagnosis). ELISA was employed to measure TRAIL levels in the group of 78 subjects with bacterial infections and 26 individuals with viral infections, and the diagnostic performance of TRAIL was identified by receiver operating characteristic (ROC) analysis. RESULTS The TRAIL level in individuals with bacterial infections was significantly lower than that in subjects with viral infections (16.59 (2.61-32.6) pg/mL vs. 97.39 (36.18-127.74) pg/mL, P < 0.05). The area under the ROC curve (AUC) of TRAIL was 0.86 (95 %CI:0.79 to 0.94) for identifying bacterial and viral infections. Combining TRAIL with C-reactive protein (CRP), the AUC was 0.94 (95 %CI:0.89 to 1.00). CONCLUSIONS TRAIL is diagnostic for discriminating between viral and bacterial infections. Combining TRAIL with CRP increases the AUC.
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Affiliation(s)
- Dandan Hu
- Geriatric Department, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Qi Yao
- Geriatric Department, The First Affiliated Hospital of Ningbo University, Ningbo, PR China.
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Channon-Wells S, Habgood-Coote D, Vito O, Galassini R, Wright VJ, Brent AJ, Heyderman RS, Anderson ST, Eley B, Martinón-Torres F, Levin M, Kaforou M, Herberg JA. Integration and validation of host transcript signatures, including a novel 3-transcript tuberculosis signature, to enable one-step multiclass diagnosis of childhood febrile disease. J Transl Med 2024; 22:802. [PMID: 39210372 PMCID: PMC11360490 DOI: 10.1186/s12967-024-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/27/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Whole blood host transcript signatures show great potential for diagnosis of infectious and inflammatory illness, with most published signatures performing binary classification tasks. Barriers to clinical implementation include validation studies, and development of strategies that enable simultaneous, multiclass diagnosis of febrile illness based on gene expression. METHODS We validated five distinct diagnostic signatures for paediatric infectious diseases in parallel using a single NanoString nCounter® experiment. We included a novel 3-transcript signature for childhood tuberculosis, and four published signatures which differentiate bacterial infection, viral infection, or Kawasaki disease from other febrile illnesses. Signature performance was assessed using receiver operating characteristic curve statistics. We also explored conceptual frameworks for multiclass diagnostic signatures, including additional transcripts found to be significantly differentially expressed in previous studies. Relaxed, regularised logistic regression models were used to derive two novel multiclass signatures: a mixed One-vs-All model (MOVA), running multiple binomial models in parallel, and a full-multiclass model. In-sample performance of these models was compared using radar-plots and confusion matrix statistics. RESULTS Samples from 91 children were included in the study: 23 bacterial infections (DB), 20 viral infections (DV), 14 Kawasaki disease (KD), 18 tuberculosis disease (TB), and 16 healthy controls. The five signatures tested demonstrated cross-platform performance similar to their primary discovery-validation cohorts. The signatures could differentiate: KD from other diseases with area under ROC curve (AUC) of 0.897 [95% confidence interval: 0.822-0.972]; DB from DV with AUC of 0.825 [0.691-0.959] (signature-1) and 0.867 [0.753-0.982] (signature-2); TB from other diseases with AUC of 0.882 [0.787-0.977] (novel signature); TB from healthy children with AUC of 0.910 [0.808-1.000]. Application of signatures outside of their designed context reduced performance. In-sample error rates for the multiclass models were 13.3% for the MOVA model and 0.0% for the full-multiclass model. The MOVA model misclassified DB cases most frequently (18.7%) and TB cases least (2.7%). CONCLUSIONS Our study demonstrates the feasibility of NanoString technology for cross-platform validation of multiple transcriptomic signatures in parallel. This external cohort validated performance of all five signatures, including a novel sparse TB signature. Two exploratory multi-class models showed high potential accuracy across four distinct diagnostic groups.
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Affiliation(s)
- Samuel Channon-Wells
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Dominic Habgood-Coote
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Ortensia Vito
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Rachel Galassini
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Victoria J Wright
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | | | - Brian Eley
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Instituto de Investigación Santiaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
| | - Michael Levin
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Jethro A Herberg
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK.
- Centre for Paediatrics and Child Health, Imperial College London, London, UK.
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Xiao Y, Zhang G. Predictive Value of a Diagnostic Five-Gene Biomarker for Pediatric Sepsis. J Inflamm Res 2024; 17:2063-2071. [PMID: 38595339 PMCID: PMC11002788 DOI: 10.2147/jir.s447588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background Pediatric sepsis has a very high morbidity and mortality rate. The purpose of this study was to evaluate diagnostic biomarkers and immune cell infiltration in pediatric sepsis. Methods Three datasets (GSE13904, GSE26378, and GSE26440) were downloaded from the gene expression omnibus (GEO) database. After identifying overlapping genes in differentially expressed genes (DEGs) and modular sepsis genes selected via a weighted gene co-expression network (WGCNA) in the GSE26378 dataset, pivotal genes were further identified by using LASSO regression and random forest analysis to construct a diagnostic model. Receiver operating characteristic curve (ROC) analysis was used to validate the efficacy of the diagnostic model for pediatric sepsis. Furthermore, we used qRT-PCR to detect the expression levels of pivotal genes and validate the diagnostic model's ability to diagnose pediatric sepsis in 65 actual clinical samples. Results Among 294 overlapping genes of DEGs and modular sepsis genes, five pivotal genes (STOM, MS4A4A, CD177, MMP8, and MCEMP1) were screened to construct a diagnostic model of pediatric sepsis. The expression of the five pivotal genes was higher in the sepsis group than in the normal group. The diagnostic model showed good diagnostic ability with AUCs of 1, 0.986, and 0.968. More importantly, the diagnostic model showed good diagnostic ability with AUCs of 0.937 in the 65 clinical samples and showed better efficacy compared to conventional inflammatory indicators such as procalcitonin (PCT), white blood cell (WBC) count, C-reactive protein (CRP), and neutrophil percentage (NEU%). Conclusion We developed and tested a five-gene diagnostic model that can reliably identify pediatric sepsis and also suggest prospective candidate genes for peripheral blood diagnostic testing in pediatric sepsis patients.
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Affiliation(s)
- Yulong Xiao
- Department of Medical Laboratory, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Genhao Zhang
- Department of Blood Transfusion, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
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Langedijk AC, Rengerink KO, Harding E, Wensing A, van Slooten R, Israeli Y, Rosenberg M, Gottlieb T, Eden E, Bont LJ. Natural variability of TRAIL, IP-10, and CRP in healthy adults - The "HERACLES" study. Cytokine 2024; 176:156530. [PMID: 38306791 DOI: 10.1016/j.cyto.2024.156530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
A novel host-protein score (called MMBV) helps to distinguish bacterial from viral infection by combining the blood concentrations of three biomarkers: tumour necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma induced protein 10 (IP-10), and C-reactive protein (CRP). These host biomarkers are differentially expressed in response to bacterial versus viral acute infection. We conducted a prospective study, with a time series design, in healthy adult volunteers in the Netherlands. The aim was to determine the variability of TRAIL, IP-10, and CRP and the MMBV score in healthy adults across time. Up to six blood samples were taken from each healthy volunteer over a period of up to four weeks. In 77 healthy participants without recent or current symptoms, MMBV scores (maximal) were bacterial in 1.3 % and viral (or other non-infectious etiology) in 93.5 % of participants. There was little variation in the mean concentrations of TRAIL (74.5 pg/ml), IP-10 (113.6 pg/ml), and CRP (1.90 mg/L) as well as the MMBV score. The variability of biomarker measurement was comparable to the precision of the measurement platform for TRAIL, IP-10, and CRP. Our findings establish the mean values of these biomarkers and MMBV in healthy individuals and indicate little variability between and within individuals over time, supporting the potential utility of this novel diagnostic to detect infection-induced changes.
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Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands.
| | | | - Eline Harding
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | | | - Rianne van Slooten
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | | | | | | | | | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
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Rautman LH, Maiga-Ascofaré O, Eibach D, Hogan B, Dekker D, Jaeger A, Akenten CW, Owusu-Dabo E, Boateng FO, Hanson H, Boahen KG, Sarpong N, Adu-Sarkodie Y, Kreuels B, May J, Krumkamp R. Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study. Trop Med Int Health 2024; 29:206-213. [PMID: 38093593 DOI: 10.1111/tmi.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Healthcare resources are often limited in areas of sub-Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria. METHODS Febrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used. RESULTS There were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One-third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria-only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic. CONCLUSIONS Suspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over-prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance.
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Affiliation(s)
- Lydia Helen Rautman
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Oumou Maiga-Ascofaré
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Hogan
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | | | - Ellis Owusu-Dabo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felix Osei Boateng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Henry Hanson
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Kennedy Gyau Boahen
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benno Kreuels
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
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7
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Jackson HR, Zandstra J, Menikou S, Hamilton MS, McArdle AJ, Fischer R, Thorne AM, Huang H, Tanck MW, Jansen MH, De T, Agyeman PKA, Von Both U, Carrol ED, Emonts M, Eleftheriou I, Van der Flier M, Fink C, Gloerich J, De Groot R, Moll HA, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia MN, Usuf E, Wright VJ, Yeung S, Zavadska D, Zenz W, Coin LJM, Casals-Pascual C, Cunnington AJ, Martinon-Torres F, Herberg JA, de Jonge MI, Levin M, Kuijpers TW, Kaforou M. A multi-platform approach to identify a blood-based host protein signature for distinguishing between bacterial and viral infections in febrile children (PERFORM): a multi-cohort machine learning study. Lancet Digit Health 2023; 5:e774-e785. [PMID: 37890901 DOI: 10.1016/s2589-7500(23)00149-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Differentiating between self-resolving viral infections and bacterial infections in children who are febrile is a common challenge, causing difficulties in identifying which individuals require antibiotics. Studying the host response to infection can provide useful insights and can lead to the identification of biomarkers of infection with diagnostic potential. This study aimed to identify host protein biomarkers for future development into an accurate, rapid point-of-care test that can distinguish between bacterial and viral infections, by recruiting children presenting to health-care settings with fever or a history of fever in the previous 72 h. METHODS In this multi-cohort machine learning study, patient data were taken from EUCLIDS, the Swiss Pediatric Sepsis study, the GENDRES study, and the PERFORM study, which were all based in Europe. We generated three high-dimensional proteomic datasets (SomaScan and two via liquid chromatography tandem mass spectrometry, referred to as MS-A and MS-B) using targeted and untargeted platforms (SomaScan and liquid chromatography mass spectrometry). Protein biomarkers were then shortlisted using differential abundance analysis, feature selection using forward selection-partial least squares (FS-PLS; 100 iterations), along with a literature search. Identified proteins were tested with Luminex and ELISA and iterative FS-PLS was done again (25 iterations) on the Luminex results alone, and the Luminex and ELISA results together. A sparse protein signature for distinguishing between bacterial and viral infections was identified from the selected proteins. The performance of this signature was finally tested using Luminex assays and by calculating disease risk scores. FINDINGS 376 children provided serum or plasma samples for use in the discovery of protein biomarkers. 79 serum samples were collected for the generation of the SomaScan dataset, 147 plasma samples for the MS-A dataset, and 150 plasma samples for the MS-B dataset. Differential abundance analysis, and the first round of feature selection using FS-PLS identified 35 protein biomarker candidates, of which 13 had commercial ELISA or Luminex tests available. 16 proteins with ELISA or Luminex tests available were identified by literature review. Further evaluation via Luminex and ELISA and the second round of feature selection using FS-PLS revealed a six-protein signature: three of the included proteins are elevated in bacterial infections (SELE, NGAL, and IFN-γ), and three are elevated in viral infections (IL18, NCAM1, and LG3BP). Performance testing of the signature using Luminex assays revealed area under the receiver operating characteristic curve values between 89·4% and 93·6%. INTERPRETATION This study has led to the identification of a protein signature that could be ultimately developed into a blood-based point-of-care diagnostic test for rapidly diagnosing bacterial and viral infections in febrile children. Such a test has the potential to greatly improve care of children who are febrile, ensuring that the correct individuals receive antibiotics. FUNDING European Union's Horizon 2020 research and innovation programme, the European Union's Seventh Framework Programme (EUCLIDS), Imperial Biomedical Research Centre of the National Institute for Health Research, the Wellcome Trust and Medical Research Foundation, Instituto de Salud Carlos III, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Grupos de Refeencia Competitiva, Swiss State Secretariat for Education, Research and Innovation.
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Affiliation(s)
- Heather R Jackson
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Judith Zandstra
- Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands; Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Stephanie Menikou
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Melissa Shea Hamilton
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Andrew J McArdle
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Roman Fischer
- Discovery Proteomics Facility, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adam M Thorne
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Honglei Huang
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael W Tanck
- Department of Epidemiology and Data Science, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Machiel H Jansen
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Tisham De
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich Von Both
- Infectious Diseases, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Marieke Emonts
- Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), School of Medicine, Panagiotis & Aglaia, Kyriakou Children's Hospital, Athens, Greece
| | - Michiel Van der Flier
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Pediatric Infectious Diseases and Immunology Amalia Children's Hospital, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands; Laboratory of Infectious Diseases, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Colin Fink
- Micropathology, University of Warwick, Warwick, UK
| | - Jolein Gloerich
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Ronald De Groot
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | | | - Marko Pokorn
- Division of Paediatrics, University Medical Centre Ljubljana and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Andrew J Pollard
- Oxford Vaccine Group Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Child Health Research Centre, The University of Queensland, Brisbane, NSW, Australia
| | - Maria N Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), School of Medicine, Panagiotis & Aglaia, Kyriakou Children's Hospital, Athens, Greece
| | - Effua Usuf
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Victoria J Wright
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Dace Zavadska
- Children's Clinical University Hospital, Rīga Stradins University, Rïga, Latvia
| | - Werner Zenz
- University Clinic of Paediatrics and Adolescent Medicine, Department of General Paediatrics, Medical University Graz, Graz, Austria
| | - Lachlan J M Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Climent Casals-Pascual
- Department of Clinical Microbiology, CDB, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Aubrey J Cunnington
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Genetics, Vaccines, Infectious Diseases, and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jethro A Herberg
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Marien I de Jonge
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands; Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute of Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Michael Levin
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Taco W Kuijpers
- Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands; Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Faculty of Medicine, and Centre for Paediatrics and Child Health, Imperial College London, London, UK.
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8
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1570-1586. [PMID: 37902340 DOI: 10.1097/ccm.0000000000006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
RATIONALE Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation. OBJECTIVES This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PANEL DESIGN The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline. METHODS We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements. RESULTS The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data. CONCLUSIONS The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
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Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, MN
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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9
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Halabi S, Shiber S, Paz M, Gottlieb TM, Barash E, Navon R, Ilan-Ber T, Shani L, Petersiel N, Grupper M, Simon E, Kirshner D, Haber D, Stein M, Maor Y, Guetta C, Lishtzinsky Y, Yanai S, Drescher MJ, Oved K, Eden E, Neuberger A, Paul M. Host test based on tumor necrosis factor-related apoptosis-inducing ligand, interferon gamma-induced protein-10 and C-reactive protein for differentiating bacterial and viral respiratory tract infections in adults: diagnostic accuracy study. Clin Microbiol Infect 2023; 29:1159-1165. [PMID: 37270059 DOI: 10.1016/j.cmi.2023.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the performance of a test (called BV), integrating the blood levels of three immune proteins into a score, to differentiate bacterial from viral infection among adults with suspected lower respiratory tract infection (LRTI). METHODS Prospective diagnostic accuracy study, enrolling febrile adults >18 years with LRTI signs or symptoms for less than 7 days presenting to several hospitals' emergency departments in Israel. The main exclusion criterion was immunodeficiency. Reference standard diagnosis (bacterial/viral/indeterminate) was based on three experts independently reviewing comprehensive patient data including follow-up data. BV generated three results: viral infection or other nonbacterial condition (0 ≤ score < 35), equivocal (35 ≤ score ≤ 65) and bacterial infection including co-infection (65 < score ≤ 100). BV performance was assessed against the reference standard with indeterminate reference standard and equivocal BV cases removed. RESULTS Of 490 enrolled patients, 415 met eligibility criteria (median age 56 years, interquartile range 35). The reference standard classified 104 patients as bacterial, 210 as viral and 101 as indeterminate. BV was equivocal in 9.6% (30/314). Excluding indeterminate reference standard diagnoses and equivocal BV results, BV's sensitivity for bacterial infection was 98.1% (101/103; 95% confidence interval 95.4-100), specificity 88.4% (160/181; 83.7-93.1) and negative predictive value 98.8% (160/162; 97.1-100). DISCUSSION BV exhibited high diagnostic performance for febrile adults with suspected LRTI among patients with reference standard diagnoses of bacterial or viral LRTI.
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Affiliation(s)
- Salim Halabi
- Emergency Department, Carmel Medical Center, Haifa, Israel
| | - Shachaf Shiber
- Emergency Department, Rabin Medical Center, Petah Tikvah, Israel
| | | | | | | | | | | | | | - Neta Petersiel
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Mordechai Grupper
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Daniel Kirshner
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Daniel Haber
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | | | - Yasmin Maor
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Claire Guetta
- Emergency Department, Rabin Medical Center, Petah Tikvah, Israel
| | - Ynon Lishtzinsky
- Emergency Department, Rabin Medical Center, Petah Tikvah, Israel
| | - Shirly Yanai
- Emergency Department, Rabin Medical Center, Petah Tikvah, Israel
| | | | | | | | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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10
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Malorey D, Lorton F, Chalumeau M, Bourgoin P, Boussicault G, Chantreuil J, Gaillot T, Roué JM, Martinot A, Assathiany R, Saulnier JP, Caillon J, Grain A, Gras-Le Guen C, Launay E. Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study. Pediatr Crit Care Med 2023; 24:e441-e451. [PMID: 37260312 DOI: 10.1097/pcc.0000000000003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs). DESIGN Secondary analysis of the available data from a prospective population-based study from 2009 to 2014. SETTING An administrative area in western France accounting for 13% of the national pediatric population. PATIENTS All children from 1 month to 16 years old admitted to a PICU or who died before admission and had a COSBI. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The time to antibiotics was divided into patient interval (from first signs of COSBI to the first medical consultation) and medical interval (from the first consultation to appropriate antibiotics administration). The association between the medical interval and child outcome was studied by a multinomial logistic regression model and the potential determinants of the patient and medical intervals were by a Cox proportional-hazards model. Of the 227 children included (median age 2.1 yr), 22 died (9.7%), and 21 (9.3%) had severe sequelae at PICU discharge. Median patient and medical intervals were 7.0 hours (interquartile range [IQR], 2.0-16.5 hr) and 3.3 hours (IQR, 1.1-12.2 hr), respectively. The last quartile of medical interval was not associated with death (adjusted odds ratio [aOR], 3.7; 95% CI, 0.8-17.5) or survival with severe sequelae (aOR, 1.3; 95% CI, 0.4-4.0) versus survival without severe sequelae. Patient interval was shorter in younger children (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.92-0.99), and medical interval was reduced when the first consultation was conducted in a hospital (aHR, 1.5; 95% CI, 1.1-2.0) versus outpatient medicine. CONCLUSIONS For children with COSBI, we found no significant association between medical interval and mortality or severe sequelae. An initial hospital referral could help reduce the time to antibiotics in COSBIs.
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Affiliation(s)
- David Malorey
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
| | - Fleur Lorton
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pierre Bourgoin
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | | | - Julie Chantreuil
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
| | - Théophile Gaillot
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Jean-Michel Roué
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
| | - Alain Martinot
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
| | - Rémy Assathiany
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
| | - Jean-Pascal Saulnier
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
| | - Jocelyne Caillon
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
| | - Audrey Grain
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Christèle Gras-Le Guen
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Elise Launay
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
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11
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Garvik OS, Póvoa P, Vinholt PJ, Nielsen SL, Jensen TG, Frederiksen H, Chen M, Dessau RB, Coia JE, Møller JK, Gradel KO. Detection of infections by computerized capture of peaks in longitudinally measured C-reactive protein levels. Biomark Med 2023; 17:635-642. [PMID: 37962480 DOI: 10.2217/bmm-2023-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
We developed four algorithms for the automatic capture of C-reactive protein (CRP) peaks in 296 adult patients with acute myeloid leukemia who had bloodstream infection (BSI) episodes, negative blood cultures (BCs) or possible infections where no BCs were performed. The algorithms detected CRP peaks for 418-446 of the 586 documented BSI episodes (71.3-76.1%) and 2714-3118 of the 4382 negative BCs (61.9-71.2%). The four algorithms captured 382-789 CRP peaks in which there were neither BSI episodes nor negative BCs. We conclude that automatic capture of CRP peaks is a tool for the monitoring of BSI episodes and possibly other infections in patients with acute myeloid leukemia.
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Affiliation(s)
- Olav Sivertsen Garvik
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
| | - Pedro Póvoa
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
- NOVA Medical School, Comprehensive Health Research Center, New University of Lisbon, Campo Mártires da Pátria 130, Lisbon, 1169-056, Portugal
- Department of Intensive Care, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, Lisbon, 1449-005, Portugal
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, Odense C, 5000, Denmark
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Kløvervænget 4, Odense C, 5000, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, University of Southern Denmark, JB Winsløws Vej 21, Second Floor, Odense C, 5000, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital and Research Unit of Hematology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Entrance 112, 12th Floor, Odense C, 5000, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Kresten Philipsens Vej 15, Aabenraa, 6200, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Ingemannsvej 46, Slagelse, 4200, Denmark
- Department of Regional Health Research, University of Southern Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital South West Jutland and Department of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Hospital Lillebaelt, Beriderbakken 4, Vejle, 7100, Denmark
- Department of Regional Health Research, University of Southern Denmark
| | - Kim Oren Gradel
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
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12
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Olliaro P, Nkeramahame J, Horgan P, Tinto H, Kiemde F, Baiden R, Adjei A, Kapisi J, Hopkins H, Salami O, Moore CE, Dittrich S, Weber S, Ongarello S. Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients <18 Years of Age With Acute Febrile Illness. Clin Infect Dis 2023; 77:S199-S205. [PMID: 37490743 PMCID: PMC10368413 DOI: 10.1093/cid/ciad324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
This meta-analysis included 3 randomized trials conducted in sub-Saharan Africa comparing the effects of point-of-care tests and diagnostic algorithms versus routine care on antibiotic prescriptions and clinical outcomes in ambulatory patients presenting at outpatient facilities with acute uncomplicated febrile illness.
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Affiliation(s)
- Piero Olliaro
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- FIND, Geneva, Switzerland
| | | | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
- Evidence & Impact Oxford, Oxford, UK
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Rita Baiden
- INDEPTH-Network, Accra, Ghana
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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13
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Harte E, Kumarasamysarma S, Phillips B, Mackay O, Rashid Z, Malikova N, Mukit A, Ramachandran S, Biju A, Brown K, Watts R, Hodges C, Tuckwell W, Wetherall N, Breen H, Price S, Szakmany T. Procalcitonin Values Fail to Track the Presence of Secondary Bacterial Infections in COVID-19 ICU Patients. Antibiotics (Basel) 2023; 12:antibiotics12040709. [PMID: 37107071 PMCID: PMC10135291 DOI: 10.3390/antibiotics12040709] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
The development of secondary bacterial infections in COVID-19 patients has been associated with increased mortality and worse clinical outcomes. Consequently, many patients have received empirical antibiotic therapies with the potential to further exacerbate an ongoing antimicrobial resistance crisis. The pandemic has seen a rise in the use of procalcitonin testing to guide antimicrobial prescribing, although its value remains elusive. This single-centre retrospective study sought to analyse the efficacy of procalcitonin in identifying secondary infections in COVID-19 patients and evaluate the proportion of patients prescribed antibiotics to those with confirmed secondary infection. Inclusion criteria comprised patients admitted to the Grange University Hospital intensive care unit with SARS-CoV-2 infection throughout the second and third waves of the pandemic. Data collected included daily inflammatory biomarkers, antimicrobial prescriptions, and microbiologically proven secondary infections. There was no statistically significant difference between PCT, WBC, or CRP values in those with an infection versus those without. A total of 57.02% of patients had a confirmed secondary infection, with 80.2% prescribed antibiotics in Wave 2, compared to 44.07% with confirmed infection and 52.1% prescribed antibiotics in Wave 3. In conclusion, procalcitonin values failed to indicate the emergence of critical care-acquired infection in COVID-19 patients.
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Affiliation(s)
- Elsa Harte
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | | | | | - Olivia Mackay
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Zohra Rashid
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | | | - Abdullah Mukit
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | | | - Anna Biju
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Kate Brown
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Rosie Watts
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Charlie Hodges
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | | | - Nick Wetherall
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Henry Breen
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Shannon Price
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Tamas Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Cardiff University, Cardiff CF14 4XN, UK
- Critical Care Directorate, Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK
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14
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Nimmagadda N, Khillare KM, Satpathy PK, Gowda BS, Narayana V, Gopal P, Tripathy S, Athavale PV. The Clinical and Laboratory Profiles of Immunocompetent Patients With Short-Duration Fever With Neutropenia in a Tertiary Care Hospital in Pune, India. Cureus 2023; 15:e34818. [PMID: 36923173 PMCID: PMC10008769 DOI: 10.7759/cureus.34818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Background Management of a febrile patient is based on understanding the pathophysiology of an abnormal temperature and temperature regulation, impacts of fever, and its treatment. In the current study, we aimed to characterize and compare the epidemiological, etiologic, microbiological, serological, clinical, and outcome traits of febrile patients with acute neutropenia admitted to a tertiary care center in Western Maharashtra. Methods Adult patients with a history of fever of less than two weeks' duration and without any immunosuppressive state were screened with predefined inclusion and exclusion criteria. General and demographic information (age and gender), and clinical examinations (type and duration of fever) were recorded. Biochemical, hematologic (total and differential cell counts), and immunologic measurements (rapid malaria, dengue, Leptospira, and viral hepatitis antigen antibodies) were performed. Data were analyzed using an appropriate statistical package. Results A total of 403 (214 males) young adults (aged: 29±11 years) with clinical presentation of fever were studied. The majority (n=361, 89.6%) had low-grade continuous fever with an average duration of 3±1 (mean±standard deviation (SD)) days. Headache and myalgia were the common symptoms present, and patients had an average hospital stay of 4±1 days. Dengue (55%) was the most common cause of febrile neutropenia, and all patients recovered well without antibiotics and granulocyte colony-stimulating factor. The mean C-reactive protein (CRP) level was 61.4±4.4 mg/L. CRP and procalcitonin (PCT) were directly correlated with the degree of neutropenia and inversely correlated with total leucocyte count (TLC). Conclusions It was highlighted from this study that antibiotics are not necessary for viral infections that have been diagnosed to stop the development of secondary bacterial infections. A clinician should be aware of "when not to use antibiotics," or the world will soon have to deal with superbugs.
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Affiliation(s)
- Nikitha Nimmagadda
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Kishor M Khillare
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Prasanna Kumar Satpathy
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Bharath S Gowda
- Gastroenterology and Hepatology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Varun Narayana
- Internal Medicine, Mahavir Institute of Medical Sciences, Vikarabad, IND
| | - Prashant Gopal
- Gastroenterology, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Srikanth Tripathy
- Central Research Facility, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Prachi V Athavale
- Microbiology, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
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15
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Göbekli A, Güney R. Experiences and practices of mothers with children 0–5 age group on fever management: A mixed methods study. J Clin Nurs 2022. [DOI: 10.1111/jocn.16593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/22/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ayşe Göbekli
- University of Health Sciences Zeynep Kamil Women and Children Diseases Training and Research Hospital, Children's Emergency Department Istanbul Turkey
| | - Rabiye Güney
- University of Health Sciences, Hamidiye Faculty of Nursing, Department of Child Health and Diseases Nursing Istanbul Turkey
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16
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Christensen EE, Binde C, Leegaard M, Tonby K, Dyrhol-Riise AM, Kvale D, Amundsen EK, Holten AR. DIAGNOSTIC ACCURACY AND ADDED VALUE OF INFECTION BIOMARKERS IN PATIENTS WITH POSSIBLE SEPSIS IN THE EMERGENCY DEPARTMENT. Shock 2022; 58:251-259. [PMID: 36130401 PMCID: PMC9584040 DOI: 10.1097/shk.0000000000001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Background: Biomarkers for early recognition of infection are warranted. The hypothesis of this study was that calprotectin, C-reactive protein (CRP), IL-6 and procalcitonin (PCT), alone or in combination, provide clinically useful information to the clinicians for early identification of infection in patients with possible sepsis in the emergency department (ED). Biomarker dynamics in the first week of hospitalization were explored. Methods: Adult patients in rapid response teams in the ED were included in a prospective observational study (n = 391). Patients who received antibiotics after biomarker availability were excluded. The ED clinician (EDC) decision whether to start antibiotics was registered. Calprotectin, CRP, IL-6, and PCT were analyzed in blood samples drawn within 15 min after ED arrival and in a subgroup for 1 week. Infection likelihood was evaluated post hoc . Results: In identifying patients with infection, CRP (area under the receiver operating characteristic curve [AUC], 0.913) and IL-6 (AUC, 0.895) were superior to calprotectin (AUC, 0.777) and PCT (AUC, 0.838). The best regression model predicting infections included EDC, CRP, and IL-6. Using optimal cutoff values, CRP and IL-6 in combination reached 95% positive and 90% negative predictive values for infection. The EDC undertreated or overtreated 65 of 391 patients (17%), and CRP and IL-6 optimal cutoff values could correct this in 32 of 65 patients (49%). Longitudinal samples revealed that IL-6 peaked in the ED, whereas CRP and PCT peaked later. Conclusion: C-reactive protein and IL-6 were superior to calprotectin and PCT for recognizing infection in patients with possible sepsis in the ED. Combining these two biomarkers with different dynamics improved recognition of infection and could aid clinical management in rapid response teams in the ED.
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Affiliation(s)
- Erik E. Christensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Christina Binde
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Marianne Leegaard
- Division of Emergencies and Critical Care, Emergency Department, Oslo University Hospital, Oslo, Norway
| | - Kristian Tonby
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Anne-Ma Dyrhol-Riise
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Dag Kvale
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Erik K. Amundsen
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Aleksander R. Holten
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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17
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A point-of-need platform for rapid measurement of a host-protein score that differentiates bacterial from viral infection: analytical evaluation. Clin Biochem 2022; 117:39-47. [PMID: 35487256 DOI: 10.1016/j.clinbiochem.2022.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 12/20/2022]
Abstract
The objective was to evaluate the analytical performance of a new point-of-need platform for rapid and accurate measurement of a host-protein score that differentiates between bacterial and viral infection. The system comprises a dedicated test cartridge (MeMed BV®) and an analyzer (MeMed Key®). In each run, three host proteins (TRAIL, IP-10 and CRP) are measured quantitatively and a combinational score (0-100) computed that indicates the likelihood of Bacterial versus Viral infection (BV score). Serum samples collected from patients with acute infection representing viral (0 ≤ score < 35), equivocal (35 ≤ score ≤ 65), or bacterial (65 < score ≤ 100) scores based on pre-defined score cutoffs were employed for the analytical evaluation studies as well as samples from healthy individuals. To assess reproducibility, triplicate runs were conducted at 3 different sites, on 2 analyzers per site over 5 non-consecutive days. Lower limit of quantitation (LLoQ) and analytical measurement range were established utilizing recombinant proteins. Sample stability was evaluated using patient samples representative of BV score range (0-100). MeMed Key® and MeMed BV® passed the acceptance criteria for each study. In the reproducibility study, TRAIL, IP-10 and CRP measurements ranged with coefficient of variation from 9.7 to 12.7%, 4.6 to 6.2% and 5.0 to 11.6%, respectively. LLoQ concentrations were established as 15 pg/mL, 100 pg/mL and 1 mg/L for TRAIL, IP-10 and CRP, respectively. To date, sample stability when frozen is 14 months. In summary, the analytical performance reported here, along with diagnostic accuracy established in the Apollo clinical validation study (NCT04690569), supports that MeMed BV® run on MeMed Key® can serve as a tool to assist clinicians in differentiating between bacterial and viral infection.
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18
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Chandna A, Richard-Greenblatt M, Tustin R, Lee SJ, Kain KC, Burza S, Lubell Y, Turner P. Practical Methods to Permit the Analysis of Host Biomarkers in Resource-Limited Settings. Am J Trop Med Hyg 2022; 106:tpmd211045. [PMID: 35436761 PMCID: PMC9209911 DOI: 10.4269/ajtmh.21-1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/28/2022] [Indexed: 11/21/2022] Open
Abstract
Host biomarker testing can be used as an adjunct to the clinical assessment of patients with infections and might be particularly impactful in resource-constrained settings. Research on the merits of this approach at peripheral levels of low- and middle-income country health systems is limited. In part, this is due to resource-intense requirements for sample collection, processing, and storage. We evaluated the stability of 16 endothelial and immune activation biomarkers implicated in the host response to infection stored in venous plasma and dried blood spot specimens at different temperatures for 6 months. We found that -80°C storage offered no clear advantage over -20°C for plasma aliquots, and most biomarkers studied could safely be stored as dried blood spots at refrigeration temperatures (4°C) for up to 3 months. These results identify more practical methods for host biomarker testing in resource-limited environments, which could help facilitate research in rural and remote environments.
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Affiliation(s)
- Arjun Chandna
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | - Melissa Richard-Greenblatt
- University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Hospital of the University of Pennsylvania, Philadelphia
| | - Richard Tustin
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sue J. Lee
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kevin C. Kain
- Department of Medicine, Division of Infectious Diseases, UHN-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Yoel Lubell
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
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19
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Torzewski J, Brunner P, Ries W, Garlichs CD, Kayser S, Heigl F, Sheriff A. Targeting C-Reactive Protein by Selective Apheresis in Humans: Pros and Cons. J Clin Med 2022; 11:jcm11071771. [PMID: 35407379 PMCID: PMC8999816 DOI: 10.3390/jcm11071771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 01/08/2023] Open
Abstract
C-reactive protein (CRP), the prototype human acute phase protein, may be causally involved in various human diseases. As CRP has appeared much earlier in evolution than antibodies and nonetheless partly utilizes the same biological structures, it is likely that CRP has been the first antibody-like molecule in the evolution of the immune system. Like antibodies, CRP may cause autoimmune reactions in a variety of human pathologies. Consequently, therapeutic targeting of CRP may be of utmost interest in human medicine. Over the past two decades, however, pharmacological targeting of CRP has turned out to be extremely difficult. Currently, the easiest, most effective and clinically safest method to target CRP in humans may be the specific extracorporeal removal of CRP by selective apheresis. The latter has recently shown promising therapeutic effects, especially in acute myocardial infarction and COVID-19 pneumonia. This review summarizes the pros and cons of applying this novel technology to patients suffering from various diseases, with a focus on its use in cardiovascular medicine.
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Affiliation(s)
- Jan Torzewski
- Cardiovascular Center Oberallgaeu-Kempten, Clinic Association Allgaeu, 87439 Kempten, Germany;
| | | | - Wolfgang Ries
- Medical Clinic, Diakonissenhospital Flensburg, 24939 Flensburg, Germany; (W.R.); (C.D.G.)
| | - Christoph D. Garlichs
- Medical Clinic, Diakonissenhospital Flensburg, 24939 Flensburg, Germany; (W.R.); (C.D.G.)
| | - Stefan Kayser
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (P.B.); (S.K.)
| | - Franz Heigl
- Medical Care Center Kempten-Allgaeu, 87439 Kempten, Germany;
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany; (P.B.); (S.K.)
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité University Medicine, 12200 Berlin, Germany
- Correspondence:
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20
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Pediatric sepsis biomarkers for prognostic and predictive enrichment. Pediatr Res 2022; 91:283-288. [PMID: 34127800 PMCID: PMC8202042 DOI: 10.1038/s41390-021-01620-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
Sepsis is a major public health problem in children throughout the world. Given that the treatment guidelines emphasize early recognition, there is interest in developing biomarkers of sepsis, and most attention is focused on diagnostic biomarkers. While there is a need for ongoing discovery and development of diagnostic biomarkers for sepsis, this review will focus on less well-known applications of sepsis biomarkers. Among patients with sepsis, the biomarkers can give information regarding the risk of poor outcome from sepsis, risk of sepsis-related organ dysfunction, and subgroups of patients with sepsis who share underlying biological features potentially amenable to targeted therapeutics. These types of biomarkers, beyond the traditional concept of diagnosis, address the important concepts of prognostic and predictive enrichment, which are key components of bringing the promise of precision medicine to the bedside of children with sepsis.
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21
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Haslam DB. Future Applications of Metagenomic Next-Generation Sequencing for Infectious Diseases Diagnostics. J Pediatric Infect Dis Soc 2021; 10:S112-S117. [PMID: 34951467 DOI: 10.1093/jpids/piab107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Metagenomic next-generation sequencing (mNGS) has the theoretical capacity to detect any microbe present in a host. mNGS also has the potential to infer a pathogen's phenotypic characteristics, including the ability to colonize humans, cause disease, and resist treatment. Concurrent host nucleic acid sequencing can assess the infected individual's physiological state, including characterization and appropriateness of the immune response. When the pathogen cannot be identified, host RNA sequencing may help infer the organism's nature. While the full promise of mNGS remains far from realization, the potential ability to identify all microbes in a complex clinical sample, assess each organism's virulence and antibiotic susceptibility traits, and simultaneously characterize the host's response to infection provide opportunities for mNGS to supplant existing technologies and become the primary method of infectious diseases diagnostics.
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Affiliation(s)
- David B Haslam
- Microbial Genomics and Metagenomics Laboratory, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Antimicrobial Stewardship Program, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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22
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Hausfater P, Charles PE. Le dosage de la procalcitonine peut-il être utile à la prise en charge d’une infection à SARS-CoV-2 aux urgences et en réanimation ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
De nombreuses études d’impact ont validé l’intérêt du dosage de la procalcitonine pour rationaliser les antibiothérapies dans les infections respiratoires basses. En l’absence d’étude prospective interventionnelle spécifiquement chez les patients atteints de Covid-19, le dosage de la procalcitonine peut cependant être utilisé aux urgences comme dans les autres IRB pour l’aide à la décision d’antibiothérapie. La majorité des infections à SARS-CoV-2 non compliquées ont des valeurs de procalcitonine inférieures à 0,25 μg/l. Parallèlement, des concentrations supérieures à 0,5 μg/l peuvent traduire un risque d’évolution vers une forme grave et/ou une co-infection bactérienne. En soins critiques, la procalcitonine est prometteuse chez les patients avec un syndrome de détresse respiratoire aiguë lié à la Covid. Chez ces patients, la pertinence de l’antibiothérapie est à reconsidérer quotidiennement, compte tenu du risque d’infection bactérienne qui évolue tout au long de séjours souvent prolongés, afin de réduire la sélection d’espèces résistantes et de limiter les toxicités.
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