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Adami ME, Giamarellos-Bourboulis EJ, Polyzogopoulou E. Towards improved point-of-care (POC) testing for patients with suspected sepsis: POC tests for host biomarkers and possible microbial pathogens. Expert Rev Mol Diagn 2024:1-11. [PMID: 39135402 DOI: 10.1080/14737159.2024.2392283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/11/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Sepsis is a heterogeneous syndrome often misdiagnosed. Point-of-care (POC) diagnostic tests are commonly used to guide decision and include host biomarkers and molecular diagnostics. AREAS COVERED The diagnostic and prognostic accuracy of established and emerging biomarkers for sepsis, including procalcitonin (PCT) soluble urokinase plasminogen activator receptor (suPAR), presepsin, TRAIL/IP-10/CRP, MxA, and MxA-CRP, are analyzed in this review. The clinical utility of the two prevalent molecular techniques for pathogens identification using polymerase chain reaction (PCR) assays is also presented: FILMARRAY and QIAstat-Dx RP. EXPERT OPINION The rising benefits of the combined use of POC biomarkers with molecular diagnostics in daily clinical routine appear to outperform conventional practices in terms of reduced turnaround time, timely diagnosis, and prompt administration of the appropriate treatment. Yet, this must be further demonstrated in future investigations. However, the cost-effectiveness of POC tests and the high rate of false positive and negative results, indicate the need for a comprehensive clinical evaluation.
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Affiliation(s)
- Maria-Evangelia Adami
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Effie Polyzogopoulou
- Department of Emergency Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Wilcox CR, Odeh N, Clark TW, Muller I, Becque T, Todd A, Islam N, Little P, Davies F, McGavin J, Francis N. Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study. J Antimicrob Chemother 2024; 79:1441-1449. [PMID: 38708643 PMCID: PMC11144485 DOI: 10.1093/jac/dkae127] [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] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION FebriDx® is a CE-marked, single-use point-of-care test with markers for bacterial [C-reactive protein (CRP)] and viral [myxovirus resistance protein A (MxA)] infection, using finger-prick blood samples. Results are available after 10-12 min. We explored the usability and potential impact of FebriDx® in reducing antibiotic prescriptions for lower respiratory tract infection (LRTI) in primary care, and the feasibility of conducting a randomized controlled trial (RCT). METHODS Patients (aged ≥1 year) with LRTI deemed likely to receive antibiotic prescription were recruited at nine general practices and underwent FebriDx® testing. Data collection included FebriDx® results, antibiotic prescribing plan (before and after testing) and re-consultation rates. Staff completed System Usability Scale questionnaires. RESULTS From 31 January 2023 to 9 June 2023, 162 participants participated (median age 57 years), with a median symptom duration of 7 days (IQR 5-14). A valid FebriDx® result was obtained in 97% (157/162). Of 155 patients with available results, 103 (66%) had no detectable CRP or MxA, 28 (18%) had CRP only, 5 (3%) had MxA only, and 19 (12%) had both CRP and MxA. The clinicians' stated management plan was to prescribe antibiotics for 86% (134/155) before testing and 45% (69/155) after testing, meaning a 41% (95% CI: 31%, 51%) difference after testing, without evidence of increased re-consultation rates. Ease-of-use questionnaires showed 'good' user-friendliness. CONCLUSIONS Use of FebriDx® to guide antibiotic prescribing for LRTI in primary care was associated with a substantial reduction in prescribing intentions. These results support a fully powered RCT to confirm its impact and safety.
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Affiliation(s)
- Christopher R Wilcox
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nour Odeh
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Alexander Todd
- Lilliput Surgery, Shore Medical Group, Elms Avenue, Poole BH14 8EE, UK
| | - Nazrul Islam
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Paul Little
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Firoza Davies
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - John McGavin
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nick Francis
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Brendish NJ, Davis C, Chapman ME, Borca F, Waddington D, Hill C, White N, Clark TW. Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation. J Infect 2024; 88:41-47. [PMID: 37977337 DOI: 10.1016/j.jinf.2023.11.003] [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: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES FebriDx is a CE-marked, FDA-approved point-of-care test that detects the antiviral host response protein Myxovirus Resistance Protein A (MxA), in addition to C-reactive protein, using finger-prick blood. FebriDx MxA detection had a high negative predictive value for COVID-19 in symptomatic adults presenting to hospital in the first waves of the pandemic and was used subsequently as a 'rule out' triage tool in Emergency departments. The diagnostic accuracy of FebriDx MxA in the current context of co-circulation of influenza, SARS-CoV-2, and Respiratory Syncytial Virus (RSV), and in the era of COVID-19 vaccination, is unknown. METHODS We retrospectively evaluated the diagnostic performance of FebriDx MxA in adults with acute respiratory symptoms presenting to the Emergency Department (ED) of a large UK teaching hospital using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the reference standard (Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV). RESULTS Between March 9th 2022 and March 8th 2023, 5426 patients had both FebriDx and RT-PCR testing with valid results. 999 (18.4%) of patients had influenza detected, 520 (9.6%) SARS-CoV-2, and 190 (3.5%) RSV. Negative Predictive Value (NPV) of MxA detection by FebriDx was 97.5% (96.9-98.0) for influenza, 97.1% (96.4-97.7) for SARS-CoV-2, 98.1% (97.5-98.6) for RSV, and 92.8% (91.8-93.7) for all viruses combined. CONCLUSIONS In symptomatic adults, FebriDx MxA had a high NPV for influenza and RSV, and retained a high NPV for SARS-CoV-2, in the context of virus co-circulation and widespread COVID-19 vaccination. FebriDx continues to be a useful 'rule out' triage tool in the ED and could potentially be scaled to provide a national triage solution for future viral pandemics.
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Affiliation(s)
- Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cai Davis
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Mary E Chapman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Daniel Waddington
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher Hill
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola White
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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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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FebriDx host-response point-of-care testing improves patient triage for coronavirus disease 2019 (COVID-19) in the emergency department. Infect Control Hosp Epidemiol 2022; 43:1049-1050. [DOI: 10.1017/ice.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mansbridge CT, Tanner AR, Beard KR, Borca F, Phan HT, Brendish NJ, Poole S, Hill C, Kiuber M, Crouch R, Waddington D, Clark TW. FebriDx host response point-of-care testing improves patient triage for coronavirus disease 2019 (COVID-19) in the emergency department. Infect Control Hosp Epidemiol 2022; 43:979-986. [PMID: 35094739 PMCID: PMC8828393 DOI: 10.1017/ice.2021.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients presenting to hospital with suspected coronavirus disease 2019 (COVID-19), based on clinical symptoms, are routinely placed in a cohort together until polymerase chain reaction (PCR) test results are available. This procedure leads to delays in transfers to definitive areas and high nosocomial transmission rates. FebriDx is a finger-prick point-of-care test (PoCT) that detects an antiviral host response and has a high negative predictive value for COVID-19. We sought to determine the clinical impact of using FebriDx for COVID-19 triage in the emergency department (ED). DESIGN We undertook a retrospective observational study evaluating the real-world clinical impact of FebriDx as part of an ED COVID-19 triage algorithm. SETTING Emergency department of a university teaching hospital. PATIENTS Patients presenting with symptoms suggestive of COVID-19, placed in a cohort in a 'high-risk' area, were tested using FebriDx. Patients without a detectable antiviral host response were then moved to a lower-risk area. RESULTS Between September 22, 2020, and January 7, 2021, 1,321 patients were tested using FebriDx, and 1,104 (84%) did not have a detectable antiviral host response. Among 1,104 patients, 865 (78%) were moved to a lower-risk area within the ED. The median times spent in a high-risk area were 52 minutes (interquartile range [IQR], 34-92) for FebriDx-negative patients and 203 minutes (IQR, 142-255) for FebriDx-positive patients (difference of -134 minutes; 95% CI, -144 to -122; P < .0001). The negative predictive value of FebriDx for the identification of COVID-19 was 96% (661 of 690; 95% CI, 94%-97%). CONCLUSIONS FebriDx improved the triage of patients with suspected COVID-19 and reduced the time that severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR-negative patients spent in a high-risk area alongside SARS-CoV-2-positive patients.
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Affiliation(s)
- Christopher T. Mansbridge
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alex R. Tanner
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kate R. Beard
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Florina Borca
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Clinical Informatics Research Unit, University of Southampton, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hang T.T. Phan
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Clinical Informatics Research Unit, University of Southampton, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nathan J. Brendish
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Stephen Poole
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Post Doctoral Fellowship Programme, University Hospital Southampton NHS Foundation Trust, Hampshire, United Kingdom
| | - Christopher Hill
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michael Kiuber
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Robert Crouch
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel Waddington
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Tristan W. Clark
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Post Doctoral Fellowship Programme, University Hospital Southampton NHS Foundation Trust, Hampshire, United Kingdom
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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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