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Iliopoulou K, Koufargyris P, Doulou S, Tasouli E, Katopodis S, Chachali SP, Schinas G, Karachalios C, Astriti M, Katsaounou P, Chrysos G, Seferlis T, Dimopoulou E, Kollia M, Poulakou G, Gerakari S, Papanikolaou IC, Milionis H, Dalekos GN, Tzavara V, Kontopoulou T, Giamarellos-Bourboulis EJ. Developing a Tool for Differentiation Between Bacterial and Viral Respiratory Infections Using Myxovirus Resistance Protein A and C-Reactive Protein. Infect Dis Ther 2024; 13:105-119. [PMID: 38112973 PMCID: PMC10828347 DOI: 10.1007/s40121-023-00901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The aim was to assess the performance of a blood assay combining measurements of MxA (myxovirus resistance protein A) and CRP (C-reactive protein) to differentiate viral from bacterial respiratory infections. METHODS In a prospective study, MxA and CRP were measured in the blood by the AFIAS panel in adults admitted with respiratory infection. Patients were split into discovery and validation cohorts. Final diagnosis was adjudicated by a panel of experts. Microbiology-confirmed cases comprised the discovery cohort, and infections adjudicated as highly probable viral or bacterial comprised the validation cohort. RESULTS A total of 537 patients were analyzed: 136 patients were adjudicated with definitive viral infections and 131 patients with definitive bacterial infections. Using logistic regression analysis, an equation was developed to calculate the probability for bacterial infection using the absolute value of MxA and CRP. Calculated probability ≥ 0.5 and/or MxA to CRP ratio less than 2 applied as the diagnostic rule for bacterial infections. This rule provided 91.6% sensitivity and 90.4% negative predictive value for the diagnosis of bacterial infections. This diagnostic sensitivity was confirmed in the validation cohort. A MxA/CRP ratio less than 0.15 was associated with unfavorable outcome. CONCLUSION The calculation of the probability for bacterial infection using MxA and CRP may efficiently discriminate between viral and bacterial respiratory infections.
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Affiliation(s)
- Konstantina Iliopoulou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Panagiotis Koufargyris
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Sarantia Doulou
- Fifth Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | - Elisavet Tasouli
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Sokratis Katopodis
- Second Department of Propedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula-Porphyria Chachali
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Georgios Schinas
- Depertment of Internal Medicine, University of Patras, Rion, Greece
| | - Charalampos Karachalios
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio General Hospital, Athens, Greece
| | - Myrto Astriti
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Paraskevi Katsaounou
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Theodoros Seferlis
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Myrto Kollia
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Garyphalia Poulakou
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Gerakari
- Emergency Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Ilias C Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Corfu "Agia Eirini", Kontokali, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110, Larissa, Greece
| | - Vasiliki Tzavara
- First Department of Internal Medicine, Korgialeneio-Benakeio General Hospital, Athens, Greece
| | - Theano Kontopoulou
- Fifth Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
- First Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
- Hellenic Institute for the Study of Sepsis, Athens, Greece.
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Tong-Minh K, Daenen K, Endeman H, Ramakers C, Gommers D, van Gorp E, van der Does Y. Performance of the FebriDx Rapid Point-of-Care Test for Differentiating Bacterial and Viral Respiratory Tract Infections in Patients with a Suspected Respiratory Tract Infection in the Emergency Department. J Clin Med 2023; 13:163. [PMID: 38202172 PMCID: PMC10779507 DOI: 10.3390/jcm13010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
FebriDx is a rapid point-of-care test combining qualitative measurements of C-reactive protein (CRP) and Myxovirus Resistance Protein A (MxA) using a disposable test device to detect and differentiate acute bacterial from viral respiratory tract infections. The goal of this study was to investigate the diagnostic accuracy of FebriDx in patients with suspected respiratory tract infections in the emergency department (ED). This was an observational cohort study, performed in the ED of an academic hospital. Patients were included if they had a suspected infection. The primary outcome was the presence of a bacterial or viral infection, determined by clinical adjudication by an expert panel. The sensitivity, specificity, and positive and negative predictive value of FebriDx for the presence of bacterial versus non-bacterial infections, and viral versus non-viral infections were calculated. Between March 2019 and November 2020, 244 patients were included. A bacterial infection was present in 41%, viral infection was present in 24%, and 4% of the patients had both viral and bacterial pathogens. FebriDx demonstrated high sensitivity in the detection of bacterial infection (87%), high NPV (91%) to rule out bacterial infection, and high specificity (94%) for viral infection in patients with a suspected infection in the ED.
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Affiliation(s)
- Kirby Tong-Minh
- Department of Emergency Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.T.-M.); (Y.v.d.D.)
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Katrijn Daenen
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - Eric van Gorp
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Internal Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Yuri van der Does
- Department of Emergency Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.T.-M.); (Y.v.d.D.)
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Metz M, Gualdoni GA, Winkler HM, Warenits AM, Stöckl J, Burgmann H, Winkler S, Oesterreicher ZA. MxA for differentiating viral and bacterial infections in adults: a prospective, exploratory study. Infection 2023; 51:1329-1337. [PMID: 36737561 PMCID: PMC9897883 DOI: 10.1007/s15010-023-01986-0] [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: 07/06/2022] [Accepted: 01/15/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Inappropriate antibiotic prescription in patients with viral infections contributes to the surge of antibiotic resistance. Viral infections induce the expression of the antiviral protein MxA in monocytes, which is a promising biomarker to differentiate between viral and bacterial diseases. In this prospective, exploratory study, we aimed to determine the diagnostic value of monocyte MxA expression in adults with viral, bacterial or co-infections. METHODS We measured monocyte MxA expression using flow cytometry in a cohort of 61 adults with various viral, bacterial and co-infections including patients receiving immunosuppressive therapy. RESULTS Monocyte MxA expression in virus-infected patients was significantly higher compared to bacterial infections (83.3 [66.8, 109.4] vs. 33.8 [29.3, 47.8] mean fluorescence intensity [MFI]; p < 0.0001) but not co-infections (53.1 [33.9, 88.9] MFI). At a threshold of 62.2 MFI, the area under the ROC curve (AUC) to differentiate between viral and bacterial infections was 0.9, with a sensitivity and specificity of 92.3% and 84.6%, respectively. Immunosuppressive therapy did not affect monocyte MxA expression in virus-infected patients. CONCLUSION Our findings corroborate the diagnostic performance of MxA in differentiating viral and bacterial infections but also point to an important caveat of MxA in viral-bacterial co-infections. This study extends previous reports and indicates that MxA is also a useful biomarker in immunocompromised patients.
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Affiliation(s)
- Matthäus Metz
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, 1090, Vienna, Austria
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090, Vienna, Austria
| | - Guido A Gualdoni
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090, Vienna, Austria
| | - Heide-Maria Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, 1090, Vienna, Austria
| | | | - Johannes Stöckl
- Institute of Immunology, Center of Pathophysiology, Infectiology, and Immunology, Medical University of Vienna, 1090, Vienna, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, 1090, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, 1090, Vienna, Austria
| | - Zoe Anne Oesterreicher
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, 1090, Vienna, Austria.
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital of St. Poelten, 3100, St. Poelten, Austria.
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Buntine P, Miller J, Pope A, Guy S, Wong FQA, McDonald H, Ahmed M, Teow KH, Roney M, Mohammadi F, Aldridge E, Hackett L, Jenner S, Davis B. Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study. BMJ Open 2022; 12:e065568. [PMID: 36581427 PMCID: PMC9805821 DOI: 10.1136/bmjopen-2022-065568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine the negative predictive value (NPV) of the FebriDx point-of-care host response device in patients presenting with symptoms suggestive of COVID-19 infection in a mostly immunised Australian emergency department (ED) population during the late 2021 phase of the COVID-19 pandemic. DESIGN Observational diagnostic accuracy study comparing FebriDx point-of-care test to SARS-CoV-2 PCR. SETTING An ED in Melbourne, Australia, with 63 000 annual presentations in 2021. PARTICIPANTS Patients aged 16 and over who met the Victorian Department of Health case definition for suspected COVID-19 infection PCR testing. Patients meeting any of the following criteria were excluded: <16 years of age; acute respiratory symptom(s) with onset>14 days prior to testing; current immunosuppressive or interferon therapy; live immunisation within the last 30 days; fever lasting>7 days; antibiotic or antiviral use in the preceding 14 days; experience of major trauma, major surgical intervention or severe burns within the last 30 days. PRIMARY AND SECONDARY OUTCOME MEASURES COVID-19 PCR results (detected, not detected) and FebriDx results (bacterial positive, viral negative, viral positive). RESULTS 94 participants were enrolled (female: 46; male: 48), 34% of participants (tested positive for COVID-19 according to PCR results, with a background incidence among all adult ED attenders of 2.5%. The sensitivity of FebriDx for detection of COVID-19 was 56% (95% CI 40% to 100%) and specificity was 92% (95% CI 84% to 100%). For the population tested, this resulted in an NPV of 80% (95% CI 71% to 100%) and a positive predictive value of 78% (95% CI 60% to 100%). CONCLUSIONS In the context of a population with low COVID-19 infection rates, an evolved variant of COVID-19 and a very high community COVID-19 vaccination rate, FebriDx demonstrated reduced sensitivity and NPV relative to results from earlier international tests. These contextual factors should be considered during any attempt to generalise the current results. TRIAL REGISTRATION NUMBER ACTRN12620001029987 (Australian Clinical Trials).
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Affiliation(s)
- Paul Buntine
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joseph Miller
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alun Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Research Dept, Analytical Insight Pty Ltd, Crawley, Western Australia, Australia
| | - Stephen Guy
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Eastern Health, Melbourne, Victoria, Australia
| | - Fang Qi Alex Wong
- Eastern Health Clinical School, Deakin University, Melbourne, Victoria, Australia
- Bairnsdale Regional Health Service, Bairnsdale, Victoria, Australia
| | - Hannah McDonald
- Eastern Health Clinical School, Deakin University, Melbourne, Victoria, Australia
- Albury Wodonga Health, Albury, New South Wales, Australia
| | - Mania Ahmed
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Kang Hui Teow
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Austin Health, Melbourne, Victoria, Australia
| | - Morgan Roney
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Farzaneh Mohammadi
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Liam Hackett
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Susanna Jenner
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
| | - Belinda Davis
- Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia
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Combined RT-PCR and Host Response Point-of-Care Testing in Patients Hospitalised with Suspected COVID-19: A Prospective Diagnostic Accuracy Study. Infect Dis Ther 2022; 11:1267-1280. [PMID: 35534764 PMCID: PMC9083481 DOI: 10.1007/s40121-022-00646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction RT-PCR has suboptimal sensitivity for the diagnosis of COVID-19. A composite reference standard comprising RT-PCR plus radiological and clinical features has been recommended for diagnostic accuracy studies. The FebriDx finger prick point-of-care test detects an antiviral host response protein (MxA) in 10 min. We evaluated the diagnostic accuracy of FebriDx and RT-PCR compared to a composite reference standard. Methods Adults presenting to hospital with suspected COVID-19 were tested by FebriDx and RT-PCR. A composite reference standard was used to classify patients as having COVID-19 based on RT-PCR positivity, or RT-PCR negativity with COVID-19 radiological findings or other clinical criteria. Measures of accuracy were calculated for MxA alone, RT-PCR alone, and both combined. This study is registered with the ISRCTN (ISRCTN14966673) and has completed. Results A total of 478 patients were tested, with valid results in 475. Of these 475 patients, 222 (46.7%) were classified as having COVID-19; 192 (40.4%) were RT-PCR positive, and 30 (6.3%) were RT-PCR negative and diagnosed on radiological/clinical criteria. Sensitivity of FebriDx MxA vs the composite reference standard was 186/222 (83.8%, 95% CI 78.3–88.4) and was similar to the sensitivity of RT-PCR (192/222 (86.5%, 95% CI 81.3–90.7), (difference of 2.7%, 95% CI − 3.9 to 9.3, p = 0.42). The sensitivity of combined FebriDx and RT-PCR was 208/222 (93.7%) which was superior to both RT-PCR alone (difference of 9.9, 95% CI 4.1–15.9; p = 0.001) and FebriDx MxA alone (difference of 7.2, 95% CI 1.6–12.9; p = 0.011). Conclusion Sensitivity of combined FebriDx and RT-PCR testing was superior to each alone for the detection of COVID-19 in hospital and may improve infection control and treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00646-4.
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Tong‐Minh K, van Hooijdonk S, Versnel MA, van Helden‐Meeuwsen CG, van Hagen PM, van Gorp ECM, Endeman H, van der Does Y, Dalm VASH, Dik WA. Blood myxovirus resistance protein-1 measurement in the diagnostic work-up of suspected COVID-19 infection in the emergency department. Immun Inflamm Dis 2022; 10:e609. [PMID: 35349755 PMCID: PMC8962640 DOI: 10.1002/iid3.609] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Myxovirus resistance protein 1 (MxA) is a biomarker that is elevated in patients with viral infections. The goal of this study was to evaluate the diagnostic value of MxA in diagnosing COVID-19 infections in the emergency department (ED) patients. METHODS This was a single-center prospective observational cohort study including patients with a suspected COVID-19 infection. The primary outcome of this study was a confirmed COVID-19 infection by RT-PCR test. MxA was assessed using an enzyme immunoassay on whole blood and receiver operating chart and area under the curve (AUC) analysis was conducted. Sensitivity, specificity, negative predictive value, and positive predictive value of MxA on diagnosing COVID-19 at the optimal cut-off of MxA was determined. RESULTS In 2021, 100 patients were included. Of these patients, 77 patients had COVID-19 infection and 23 were non-COVID-19. Median MxA level was significantly higher (p < .001) in COVID-19 patients compared to non-COVID-19 patients, respectively 1933 and 0.1 ng/ml. The AUC of MxA on a confirmed COVID-19 infection was 0.941 (95% CI: 0.867-1.000). The optimal cut-off point of MxA was 252 ng/ml. At this cut-off point, the sensitivity of MxA on a confirmed COVID-19 infection was 94% (95% CI: 85%-98%) and the specificity was 91% (95% CI: 72%-99%). CONCLUSION MxA accurately distinguishes COVID-19 infections from bacterial infections and noninfectious diagnoses in the ED in patients with a suspected COVID-19 infection. If the results can be validated, MxA could improve the diagnostic workup and patient flow in the ED.
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Affiliation(s)
- Kirby Tong‐Minh
- Department of Emergency MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Samantha van Hooijdonk
- Department of Emergency MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Marjan A. Versnel
- Department of ImmunologyErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Petrus Martin van Hagen
- Department of ImmunologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Internal MedicineSection of Allergy & Clinical Immunology, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Eric C. M. van Gorp
- Department of ViroscienceErasmus University Medical CenterRotterdamThe Netherlands
| | - Henrik Endeman
- Department of Intensive CareErasmus University Medical CenterRotterdamThe Netherlands
| | - Yuri van der Does
- Department of Emergency MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Virgil A. S. H. Dalm
- Department of ImmunologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Internal MedicineSection of Allergy & Clinical Immunology, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of ImmunologyErasmus University Medical CenterRotterdamThe Netherlands
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FebriDx for rapid screening of patients with suspected COVID-19 upon hospital admission: systematic literature review and meta-analysis. J Hosp Infect 2022; 123:61-66. [PMID: 35202747 PMCID: PMC8858770 DOI: 10.1016/j.jhin.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 12/30/2022]
Abstract
A systematic literature review and meta-analysis was undertaken of the lateral flow-based FebriDx immunoassay for triaging patients with suspected coronavirus disease 2019 (COVID-19) upon admission to healthcare facilities. An electronic search was conducted in Scopus and Medline using the keywords ‘FebriDx’ AND ‘COVID-19’ OR ‘SARS-CoV-2’, with no language or date (i.e. up to 4th February 2022) limits, selecting studies where FebriDx was used for triaging patients with suspected COVID-19 in acute care settings, and reporting sufficient data to construct a 2×2 table. Five studies were included in the final analysis, totalling 2309 patients. The pooled diagnostic sensitivity and specificity were 0.91 [95% confidence interval (CI) 0.88–0.93] and 0.92 (95% CI 0.90–0.93), whilst the area under the curve, accuracy and kappa statistics were 0.971 (95% CI 0.962–0.980), 91.4% (95% CI 90.2–92.5%) and 0.762 (95% CI 0.731–0.793), respectively, thus reflecting substantial agreement with reference molecular testing techniques. Negative and positive predictive values were 0.974 (95% CI 0.966–0.981) and 0.742 (95% CI 0.711–0.770), respectively. This pooled analysis demonstrated that FebriDx has clinical value for rapid screening of patients with suspected COVID-19 in acute care settings, especially in regions with high viral circulation in which the pre-test probability is high, and enables prioritization for confirmatory laboratory testing.
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Dick K, Schneider J. Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:56-62. [PMID: 34703832 PMCID: PMC8483888 DOI: 10.36469/001c.27753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Background: Acute respiratory infections (ARIs) are commonly treated with antibiotics in outpatient settings, but many infections are caused by viruses and antibiotic treatment is therefore inappropriate. FebriDx®, a rapid point-of-care test that can differentiate viral from bacterial infections, can inform antibiotic treatment decisions. Objectives: The primary aim of this study is to conduct a literature-based US economic evaluation of a novel rapid point-of-care test, FebriDx®, that simultaneously measures two key infection biomarkers, C-reactive protein (CRP) and Myxovirus resistance protein A (MxA), to accurately differentiate viral from bacterial infection. Methods: A budget impact model was developed based on a review of published literature on antibiotic prescribing for ARIs in the United States. The model considers the cost of antibiotic treatment, antibiotic resistant infections, antibiotic-related adverse events, and point-of-care testing. These costs were extrapolated to estimate savings on a national level. Results: The expected national cost to treat ARIs under standard of care was US $8.25 billion, whereas the expected national cost of FebriDx point-of-care-guided ARI treatment was US $5.74 billion. Therefore, the expected national savings associated with FebriDx® rapid point-of-care testing was US $2.51 billion annually. Conclusions: FebriDx, a point of care test that can reliably aid in the differentiation of viral and bacterial infections, can reduce antibiotic misuse and, therefore, antibiotic resistant infections. This results in significant cost savings, driven primarily by the reduction in antibiotic resistant infections.
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Houston H, Deas G, Naik S, Shah K, Patel S, Greca Dottori M, Tay M, Filson SA, Biggin-Lamming J, Ross J, Vaughan N, Vaid N, Gopal Rao G, Amin AK, Gupta-Wright A, John L. Utility of the FebriDx point-of-care assay in supporting a triage algorithm for medical admissions with possible COVID-19: an observational cohort study. BMJ Open 2021; 11:e049179. [PMID: 34373308 PMCID: PMC8354759 DOI: 10.1136/bmjopen-2021-049179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay. DESIGN Retrospective observational cohort. SETTING Large acute National Health Service hospital in London, UK. PARTICIPANTS All medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result. INTERVENTIONS Medical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19. PRIMARY OUTCOME MEASURES Diagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard. RESULTS 4.0% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46% (80/175) in those triaged as likely, 4.1% (50/1225) in possible and 0.3% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96% (95% CI 91% to 98%) and specificity of 61.5% (95% CI 59.8% to 63.1%), while the triage algorithm including FebriDx had sensitivity of 93% (95% CI 87% to 96%) and specificity of 86.4% (95% CI 85.2% to 87.5%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19. CONCLUSIONS A triage algorithm including the FebriDx assay had good sensitivity and was useful to 'rule-out' COVID-19 among medical admissions to hospital.
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Affiliation(s)
- Hamish Houston
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Gavin Deas
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Shivam Naik
- School of Medicine, Imperial College London, London, UK
| | - Kamal Shah
- School of Medicine, Imperial College London, London, UK
| | - Shiras Patel
- School of Medicine, Imperial College London, London, UK
| | | | - Michael Tay
- School of Medicine, Imperial College London, London, UK
| | - Sarah Ann Filson
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - James Biggin-Lamming
- Transformation Programme Director, London North West University Healthcare NHS Trust, London, UK
| | - John Ross
- Emergency Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Natalie Vaughan
- Department of Pathology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Nidhi Vaid
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Guduru Gopal Rao
- Department of Microbiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
- Department of Medicine, Imperial College London, London, UK
| | - Amit K Amin
- Department of Microbiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ankur Gupta-Wright
- Institute for Global Health, University College London, London, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Laurence John
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
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