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Farnsworth CW, Roemmich B, Spears GM, Murray DL, Dispenzieri A, Willrich MAV. Clinical specificity of two assays for immunoglobulin kappa and lambda free light chains. Clin Chem Lab Med 2024; 62:929-938. [PMID: 38044587 DOI: 10.1515/cclm-2023-0912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Free light chain (FLC) assays and the ratio of κ/λ are recommended for diagnosis, prognosis and monitoring of plasma cell dyscrasias (PCD). Limited data exists on FLC clinical specificity in patients diagnosed with other conditions. METHODS We assessed the κ, λ, and κ/λ FLC ratio using the FreeLite assay and the Sebia FLC ELISA assay in 176 patients with clinical presentations of fatigue, anemia, polyclonal hypergammaglobulinemia, joint disorders, kidney disease and non PCD-cancers with no monoclonal protein observed on serum protein electrophoresis or MASS-FIX immunoglobulin isotyping. Manufacturer defined reference intervals (RI) and glomerular filtration rate (GFR) specific RI (renal RI) were utilized. RESULTS For the κ/λ ratio, 68.7 % (121/176) of specimens on the FreeLite and 87.5 % (154/176) of specimens on the Sebia assay were within RI. For κ, 68.2 % (120/176) and 72.2 % (127/176) of results were outside RI for FreeLite and Sebia respectively. For λ, 37.5 % (66/176) and 84.1 % (148/176) of FreeLite and Sebia results were outside RI. With FreeLite and Sebia, patients with kidney disease (n=25) had the highest κ/λ ratios. 44 patients (25.0 %) had GFR <60 mL/min/BSA. When renal RI were applied, 13.6 % had a FLCr outside the renal RI with FreeLite, and 4.5 % with Sebia. CONCLUSIONS In a cohort of patients with signs and symptoms suggestive of PCDs, but ultimately diagnosed with other conditions, Sebia FLC had improved clinical specificity relative to FreeLite, if one was using an abnormal κ/λ ratio as a surrogate for monoclonality.
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Affiliation(s)
| | | | - Grant M Spears
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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2
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Farnsworth CW, El-Khoury JM, Pyle-Eilola AL, Wheeler S. Abstracts from the Third AACC Preanalytical Phase Conference: Implementing Preanalytical Tools That Improve Patient Care. J Appl Lab Med 2024; 9:408-411. [PMID: 38253382 DOI: 10.1093/jalm/jfad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University in St.Louis, St. Louis, MO, United States
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Amy L Pyle-Eilola
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pathology, The Ohio State Wexner Medical Center, Columbus, OH, United States
| | - Sarah Wheeler
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Spies NC, Hubler Z, Azimi V, Zhang R, Jackups R, Gronowski AM, Farnsworth CW, Zaydman MA. Automating the Detection of IV Fluid Contamination Using Unsupervised Machine Learning. Clin Chem 2024; 70:444-452. [PMID: 38084963 DOI: 10.1093/clinchem/hvad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/09/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Intravenous (IV) fluid contamination is a common cause of preanalytical error that can delay or misguide treatment decisions, leading to patient harm. Current approaches for detecting contamination rely on delta checks, which require a prior result, or manual technologist intervention, which is inefficient and vulnerable to human error. Supervised machine learning may provide a means to detect contamination, but its implementation is hindered by its reliance on expert-labeled training data. An automated approach that is accurate, reproducible, and practical is needed. METHODS A total of 25 747 291 basic metabolic panel (BMP) results from 312 721 patients were obtained from the laboratory information system (LIS). A Uniform Manifold Approximation and Projection (UMAP) model was trained and tested using a combination of real patient data and simulated IV fluid contamination. To provide an objective metric for classification, an "enrichment score" was derived and its performance assessed. Our current workflow was compared to UMAP predictions using expert chart review. RESULTS UMAP embeddings from real patient results demonstrated outliers suspicious for IV fluid contamination when compared with the simulated contamination's embeddings. At a flag rate of 3 per 1000 results, the positive predictive value (PPV) was adjudicated to be 0.78 from 100 consecutive positive predictions. Of these, 58 were previously undetected by our current clinical workflows, with 49 BMPs displaying a total of 56 critical results. CONCLUSIONS Accurate and automatable detection of IV fluid contamination in BMP results is achievable without curating expertly labeled training data.
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Affiliation(s)
- Nicholas C Spies
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Zita Hubler
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Vahid Azimi
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Ray Zhang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ronald Jackups
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Ann M Gronowski
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Christopher W Farnsworth
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
| | - Mark A Zaydman
- Department of Pathology, Washington University in St.Louis School of Medicine, St. Louis, MO, United States
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4
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Weli H, Farnsworth CW. Implementing point-of-care hemoglobin A1C testing in an obstetrics outpatient clinic. Lab Med 2024:lmad112. [PMID: 38217552 DOI: 10.1093/labmed/lmad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND A1C ≥6.0% is associated with increased risk of adverse outcomes in pregnant diabetic patients. A1C testing is recommended by the American Diabetes Association as a secondary measure of glycemic control in pregnant patients. OBJECTIVE To determine the utility of A1C point-of-care testing (POCT) during pregnancy to facilitate rapid counseling and diabetes care, particularly in relatively low-income transient patient populations. METHODS We performed a single-center, retrospective analysis of patients presenting to an outpatient obstetrics office with routine, in-laboratory A1C testing, before and after the implementation of POCT for A1C (n = 70 and n = 75, respectively). Demographics, results, physician referral to a nutritionist, counseling, and outcomes were retrieved from patient electronic medical records. RESULTS In total, 9% and 23% of the in-laboratory and POCT groups, respectively, were referred for nutrition services (P = .02). Of these, 22% of the in-laboratory group and 42% of the POCT group received immediate counseling (P < .01). An inverse correlation was observed between A1C level at study entry and gestational weeks at delivery, with a Pearson r value of -0.39 (-0.58 to -0.16) for the in-laboratory group and -0.38 (-0.57 to -0.14) for the POCT group. No statistically significant difference in pregnancy outcomes was observed. CONCLUSION Implementation of A1C POCT was associated with immediate counseling and management of the health of pregnant patients, but was not associated with improved outcomes, in a low-resource patient population.
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Affiliation(s)
- Homayemem Weli
- Department of Pathology & Immunology, Washington University, St Louis, MO
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5
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Farnsworth CW. Commentary on Positive Syphilis Serologies after Intravenous Immunoglobulin Treatment: A Diagnostic Confusion That Needs Emphasis. Clin Chem 2023; 69:1346-1347. [PMID: 38037442 DOI: 10.1093/clinchem/hvad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO 63110, United States
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Hubler ZML, Farnsworth CW, Spies NC. Asymptomatic Hyponatremia and Hyperkalemia in a Patient with Leukemic Leukocytosis. Clin Chem 2023; 69:1322-1323. [PMID: 37932107 DOI: 10.1093/clinchem/hvad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/06/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Zita M L Hubler
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO, United States
| | - Nicholas C Spies
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO, United States
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Spies NC, Hubler Z, Roper SM, Omosule CL, Senter-Zapata M, Roemmich BL, Brown HM, Gimple R, Farnsworth CW. GPT-4 Underperforms Experts in Detecting IV Fluid Contamination. J Appl Lab Med 2023; 8:1092-1100. [PMID: 37702018 DOI: 10.1093/jalm/jfad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Specimens contaminated with intravenous (IV) fluids are common in clinical laboratories. Current methods for detecting contamination rely on insensitive and workflow-disrupting delta checks or manual technologist review. Herein, we assessed the utility of large language models for detecting contamination by IV crystalloids and compared its performance to multiple, but variably trained healthcare personnel (HCP). METHODS Contamination of basic metabolic panels was simulated using 0.9% normal saline (NS), with (n = 30) and without (n = 30) 5% dextrose (D5NS), at mixture ratios of 0.10 and 0.25. A multimodal language model (GPT-4) and a diverse panel of 8 HCP were asked to adjudicate between real and contaminated results. Classification performance, mixture quantification, and confidence was compared by Wilcoxon rank sum. RESULTS The 95% CIs for accuracy were 0.57-0.71 vs 0.73-0.80 for GPT-4 and HCP, respectively, on the NS set and 0.57-0.57 vs 0.73-0.80 on the D5NS set. HCP overestimated severity of contamination in the 0.10 mixture group (95% CI of estimate error, 0.05-0.20) for both fluids, while GPT-4 markedly overestimated the D5NS mixture at both ratios (0.16-0.33 for NS, 0.11-0.35 for D5NS). There was no correlation between reported confidence and likelihood of a correct classification. CONCLUSIONS GPT-4 is less accurate than trained HCP for detecting IV fluid contamination of basic metabolic panel results. However, trained individuals were imperfect at identifying contaminated specimens implying the need for novel, automated tools for its detection.
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Affiliation(s)
- Nicholas C Spies
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Zita Hubler
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Stephen M Roper
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Catherine L Omosule
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Michael Senter-Zapata
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Brittany L Roemmich
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Hannah Marie Brown
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ryan Gimple
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Mellett L, Amarasinghe G, Farnsworth CW, Khader SA. Elevated Level of Circulating but Not Urine S100A8/A9 Identifies Poor COVID-19 Outcomes. ACS Infect Dis 2023; 9:1815-1820. [PMID: 37787461 PMCID: PMC10580308 DOI: 10.1021/acsinfecdis.3c00249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 10/04/2023]
Abstract
The alarmin calprotectin (S100A8/A9) is thought to drive a cytokine storm, a hallmark of severe COVID-19. Recent studies report circulating S100A8/A9 levels can distinguish COVID-19 severity but have only been conducted in non-U.S. cohorts and mainly focus on serum S100A8/A9 levels. Thus, we quantified S100A8/A9 in serum and urine samples from a hospital cohort in St. Louis, Missouri, to expand the understanding of S100A8/A9 as a prognostic biomarker for COVID-19. Elevated S100A8/A9 serum levels were observed in ICU patients (n = 49, p = 0.0370) and patients with fatal cases of COVID-19 (n = 76, p = 0.0018). We observed no correlation in the S100A8/A9 levels in matched serum and urine samples. Our results support the association of serum S100A8/A9 levels with COVID-19 severity and suggest that further investigation of urine S100A8/A9 as a COVID-19 biomarker is not warranted.
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Affiliation(s)
- Leah Mellett
- Department
of Molecular Microbiology, Washington University
in St. Louis, St. Louis, Missouri 63108, United States
- Department
of Pathology and Immunology, Washington
University School of Medicine, St. Louis, Missouri 63108, United States
| | - Gaya Amarasinghe
- Department
of Pathology and Immunology, Washington
University School of Medicine, St. Louis, Missouri 63108, United States
| | - Christopher W. Farnsworth
- Department
of Pathology and Immunology, Washington
University School of Medicine, St. Louis, Missouri 63108, United States
| | - Shabaana A. Khader
- Department
of Molecular Microbiology, Washington University
in St. Louis, St. Louis, Missouri 63108, United States
- Department
of Microbiology, University of Chicago, Chicago, Illinois 60637 United States
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9
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Filip AB, Farnsworth CW, Mullins ME, Crews BO, Kraut JA. Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection. J Med Toxicol 2023; 19:362-367. [PMID: 37695470 PMCID: PMC10522546 DOI: 10.1007/s13181-023-00967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG. METHODS This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay. RESULTS Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were "positive." At the manufacturer's threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7-100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of -5.3 (-8.9 to -1.7). CONCLUSIONS The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.
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Affiliation(s)
- Ari B Filip
- Arkansas Poison and Drug Information Center, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA.
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bridgit O Crews
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey A Kraut
- Medical and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA; UCLA Membrane Biology Laboratory, Division of Nephrology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Lin Y, Riek AE, Gronowski AM, Farnsworth CW. Limited Utility of Free Triiodothyronine Testing. J Appl Lab Med 2023; 8:847-855. [PMID: 37473430 DOI: 10.1093/jalm/jfad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/31/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Free triiodothyronine (fT3) testing is most useful when thyroid stimulating hormone (TSH) is suppressed, and free thyroxine (fT4) is normal or decreased. These laboratory values in a symptomatic patient are referred to as T3 thyrotoxicosis. Standards for fT3 reflex testing have not been established. Herein, we examined the clinical utility of fT3 with the goal of identifying a TSH cutoff in the context of normal/decreased fT4 that maximizes the utility of measuring fT3. METHODS TSH, fT4, and fT3 results between January 2016 and October 2021 were extracted from the laboratory information system and grouped if resulted on the same day for the same patient. Frequency of biochemical T3 thyrotoxicosis was evaluated at different TSH cutoffs and in outpatient vs inpatient settings. RESULTS Of the 4366 TSH-fT4-fT3 results, 70 (1.6%) were consistent with biochemical T3 thyrotoxicosis. The common reasons were previously diagnosed hyperthyroidism on antithyroid medication (n = 28) or hypothyroidism on thyroid medication (n = 18) and newly diagnosed hyperthyroidism (n = 20, 0.5%). The likelihood of detecting T3 thyrotoxicosis increased with lower TSH cutoff (<0.3 μIU/mL, 10.3% vs <0.0 1μIU/mL, 27.6%). All patients with newly diagnosed hyperthyroidism had TSH <0.01 μIU/mL. Higher frequency of T3 thyrotoxicosis was observed in the outpatient setting (34%) relative to the inpatient setting (14%, P < 0.001) when TSH < 0.01 μIU/mL. CONCLUSIONS T3 thyrotoxicosis is a relatively rare diagnosis and fT3 measurement has limited utility in the vast majority of patients. A fT3 reflex for patients with TSH <0.01 μIU/mL and normal/low fT4 may improve clinical utility and reduce unnecessary testing, especially in the outpatient setting.
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Affiliation(s)
- Yanchun Lin
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Amy E Riek
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Farnsworth CW, O’Neil CA, Dalton C, McDonald D, Vogt L, Hock K, Arter O, Wallace MA, Muenks C, Amor M, Alvarado K, Peacock K, Jolani K, Fraser VJ, Burnham CAD, Babcock HM, Budge PJ, Kwon JH. Association between SARS-CoV-2 Symptoms, Ct Values, and Serological Response in Vaccinated and Unvaccinated Healthcare Personnel. J Appl Lab Med 2023; 8:871-886. [PMID: 37478837 PMCID: PMC10482509 DOI: 10.1093/jalm/jfad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND SARS-CoV-2 vaccines are effective at reducing symptomatic and asymptomatic COVID-19. Limited studies have compared symptoms, threshold cycle (Ct) values from reverse transcription (RT)-PCR testing, and serological testing results between previously vaccinated vs unvaccinated populations with SARS-CoV-2 infection. METHODS Healthcare personnel (HCP) with a positive SARS-CoV-2 RT-PCR test within the previous 14 to 28 days completed surveys including questions about demographics, medical conditions, social factors, and symptoms of COVID-19. Ct values were observed, and serological testing was performed for anti-nucleocapsid (anti-N) and anti-Spike (anti-S) antibodies at enrollment and 40 to 90 days later. Serological results were compared to HCP with no known SARS-CoV-2 infection and negative anti-N testing. RESULTS There were 104 unvaccinated/not fully vaccinated and 77 vaccinated HCP with 2 doses of an mRNA vaccine at time of infection. No differences in type or duration of symptoms were reported (P = 0.45). The median (interquartile range [IQR]) Ct was 21.4 (17.6-24.6) and 21.5 (18.1-24.6) for the unvaccinated and vaccinated HCP, respectively. Higher anti-N IgG was observed in unvaccinated HCP (5.08 S/CO, 3.08-6.92) than vaccinated (3.61 signal to cutoff ratio [S/CO], 2.16-5.05). Anti-S IgG was highest among vaccinated HCP with infection (34 285 aribitrary units [AU]/mL, 17 672-61 775), followed by vaccinated HCP with no prior infection (1452 AU/mL, 791-2943), then unvaccinated HCP with infection (829 AU/mL, 290-1555). Anti-S IgG decreased 1.56% (0.9%-1.79%) per day in unvaccinated and 0.38% (0.03%-0.94%) in vaccinated HCP. CONCLUSIONS Vaccinated HCP infected with SARS-CoV-2 reported comparable symptoms and had similar Ct values relative to unvaccinated. However, vaccinated HCP had increased and prolonged anti-S and decreased anti-N response relative to unvaccinated.
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Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Caroline A O’Neil
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Claire Dalton
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - David McDonald
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Lucy Vogt
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Karl Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Olivia Arter
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Carol Muenks
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mostafa Amor
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Kelly Alvarado
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kate Peacock
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Kevin Jolani
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Victoria J Fraser
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hilary M Babcock
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Phillip J Budge
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Jennie H Kwon
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
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12
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Diorio-Toth L, Wallace MA, Farnsworth CW, Wang B, Gul D, Kwon JH, Andleeb S, Burnham CAD, Dantas G. Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids. mSystems 2023; 8:e0020623. [PMID: 37439570 PMCID: PMC10469867 DOI: 10.1128/msystems.00206-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023] Open
Abstract
Contamination of hospital sinks with microbial pathogens presents a serious potential threat to patients, but our understanding of sink colonization dynamics is largely based on infection outbreaks. Here, we investigate the colonization patterns of multidrug-resistant organisms (MDROs) in intensive care unit sinks and water from two hospitals in the USA and Pakistan collected over 27 months of prospective sampling. Using culture-based methods, we recovered 822 bacterial isolates representing 104 unique species and genomospecies. Genomic analyses revealed long-term colonization by Pseudomonas spp. and Serratia marcescens strains across multiple rooms. Nanopore sequencing uncovered examples of long-term persistence of resistance-conferring plasmids in unrelated hosts. These data indicate that antibiotic resistance (AR) in Pseudomonas spp. is maintained both by strain colonization and horizontal gene transfer (HGT), while HGT maintains AR within Acinetobacter spp. and Enterobacterales, independent of colonization. These results emphasize the importance of proactive, genomic-focused surveillance of built environments to mitigate MDRO spread. IMPORTANCE Hospital sinks are frequently linked to outbreaks of antibiotic-resistant bacteria. Here, we used whole-genome sequencing to track the long-term colonization patterns in intensive care unit (ICU) sinks and water from two hospitals in the USA and Pakistan collected over 27 months of prospective sampling. We analyzed 822 bacterial genomes, representing over 100 different species. We identified long-term contamination by opportunistic pathogens, as well as transient appearance of other common pathogens. We found that bacteria recovered from the ICU had more antibiotic resistance genes (ARGs) in their genomes compared to matched community spaces. We also found that many of these ARGs are harbored on mobilizable plasmids, which were found shared in the genomes of unrelated bacteria. Overall, this study provides an in-depth view of contamination patterns for common nosocomial pathogens and identifies specific targets for surveillance.
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Affiliation(s)
- Luke Diorio-Toth
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bin Wang
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Danish Gul
- Atta ur Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Jennie H. Kwon
- Department of Medicine, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
| | - Saadia Andleeb
- Atta ur Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St Louis, St. Louis, Missouri, USA
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13
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Bosserman RE, Farnsworth CW, O’Neil CA, Cass C, Park D, Ballman C, Wallace MA, Struttmann E, Stewart H, Arter O, Peacock K, Fraser VJ, Budge PJ, Olsen MA, Burnham CAD, Babcock HM, Kwon JH. Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare personnel in the Midwestern United States, September 2020-April 2021. Antimicrob Steward Healthc Epidemiol 2023; 3:e133. [PMID: 37592963 PMCID: PMC10428156 DOI: 10.1017/ash.2022.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 08/19/2023]
Abstract
Objective To determine the prevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG nucleocapsid (N) antibodies among healthcare personnel (HCP) with no prior history of COVID-19 and to identify factors associated with seropositivity. Design Prospective cohort study. Setting An academic, tertiary-care hospital in St. Louis, Missouri. Participants The study included 400 HCP aged ≥18 years who potentially worked with coronavirus disease 2019 (COVID-19) patients and had no known history of COVID-19; 309 of these HCP also completed a follow-up visit 70-160 days after enrollment. Enrollment visits took place between September and December 2020. Follow-up visits took place between December 2020 and April 2021. Methods At each study visit, participants underwent SARS-CoV-2 IgG N-antibody testing using the Abbott SARS-CoV-2 IgG assay and completed a survey providing information about demographics, job characteristics, comorbidities, symptoms, and potential SARS-CoV-2 exposures. Results Participants were predominately women (64%) and white (79%), with median age of 34.5 years (interquartile range [IQR], 30-45). Among the 400 HCP, 18 (4.5%) were seropositive for IgG N-antibodies at enrollment. Also, 34 (11.0%) of 309 were seropositive at follow-up. HCP who reported having a household contact with COVID-19 had greater likelihood of seropositivity at both enrollment and at follow-up. Conclusions In this cohort of HCP during the first wave of the COVID-19 pandemic, ∼1 in 20 had serological evidence of prior, undocumented SARS-CoV-2 infection at enrollment. Having a household contact with COVID-19 was associated with seropositivity.
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Affiliation(s)
- Rachel E. Bosserman
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Caroline A. O’Neil
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Candice Cass
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel Park
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Claire Ballman
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Emily Struttmann
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Henry Stewart
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Olivia Arter
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kate Peacock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Philip J. Budge
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Hilary M. Babcock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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14
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Omosule CL, Hock KG, Dalton C, Scalpati A, Gronowski AM, Brants A, Farnsworth CW. Method Comparison and Workflow Differences Using the Same Free Light Chain Assay on 2 Analyzer Platforms. J Appl Lab Med 2023; 8:689-699. [PMID: 37186660 DOI: 10.1093/jalm/jfad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/13/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The Freelite assay (The Binding Site) is utilized to quantify serum immunoglobulin free light chains (sFLC), which is crucial for diagnosing and monitoring plasma cell dyscrasias (PCDs). Using the Freelite test, we compared methods and evaluated workflow differences across two analyzer platforms. METHODS sFLC concentrations were measured in 306 fresh serum specimens (cohort A) and 48 frozen specimens with documented sFLC >20 mg/dL (cohort B). Specimens were analyzed on the Roche cobas 8000 and Optilite analyzers using the Freelite κ and λ assays. Performance was compared using Deming regression. Workflow was compared by assessing turnaround time (TAT) and reagent usage. RESULTS For cohort A specimens, Deming regression revealed a slope of 1.04 (95% CI, 0.88-1.02) and an intercept of -0.77 (95% CI, -0.57 to 1.85) for sFLCκ and a slope of 0.90 (95% CI, -0.04 to 1.83) and intercept of 1.59 (95% CI, -3.12 to 6.25) for sFLCλ. Regression of the κ/λ ratio revealed a slope of 2.44 (95% CI, 1.47-3.41) and intercept of -8.13 (95% CI, -16.82 to 0.58) with a concordance kappa of 0.80 (95% CI, 0.69-0.92). The proportion of specimens with TAT >60 min was 0.33% and 8% for the Optilite and cobas, respectively (P < 0.001). The Optilite required 49 (P < 0.001) and 12 (P = 0.016) fewer tests for sFLCκ and sFLCλ relative to the cobas. Cohort B specimens showed similar but more dramatic results. CONCLUSIONS Analytical performance of the Freelite assays was comparable on the Optilite and cobas 8000 analyzers. In our study, the Optilite required less reagent, had a slightly reduced TAT, and eliminated manual dilutions for samples with sFLC concentrations >20 mg/dL.
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Affiliation(s)
- Catherine L Omosule
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Karl G Hock
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Claire Dalton
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | | | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Aigars Brants
- The Binding Site, Inc., San Diego, CA, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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15
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Franks CE, Li J, Martinez M, Farnsworth CW, Jones PM, Grenache DG, Meng QH, Gronowski AM. Utility of Commercially Available Quantitative hCG Immunoassays as Tumor Markers in Trophoblastic and Non-Trophoblastic Disease. Clin Chem 2023:7173311. [PMID: 37205831 DOI: 10.1093/clinchem/hvad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/23/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The use of quantitative human chorionic gonadotropin (hCG) as a tumor marker is widely accepted despite lack of FDA-approval for oncology. Differences in iso- and glycoform recognition among hCG immunoassays is well established, exhibiting wide inter-method variability. Here, we assess the utility of 5 quantitative hCG immunoassays for use as tumor markers in trophoblastic and non-trophoblastic disease. METHODS Remnant specimens were obtained from 150 patients with gestational trophoblastic disease (GTD), germ cell tumors (GCT), or other malignancies. Specimens were identified by review of results from physician-ordered hCG and tumor marker testing. Five analyzer platforms were used for split specimen analysis of hCG: Abbott Architect Total, Roche cobas STAT, Roche cobas Total, Siemens Dimension Vista Total, and Beckman Access Total. RESULTS Frequency of elevated hCG concentrations (above reference cutoffs) was highest in GTD (100%), followed by GCT (55% to 57%), and other malignancies (8% to 23%). Overall, the Roche cobas Total detected elevated hCG in the greatest number of specimens (63/150). Detection of elevated hCG in trophoblastic disease was nearly equivalent among all immunoassays (range, 41 to 42/60). CONCLUSIONS While no immunoassay is likely to be perfect in all clinical situations, results for the 5 hCG immunoassays evaluated suggest that all are adequate for use of hCG as a tumor marker in gestational trophoblastic disease and select germ cell tumors. Further harmonization of hCG methods is needed as serial testing for biochemical tumor monitoring must still be performed using a single method. Additional studies are needed to assess the utility of quantitative hCG as a tumor marker in other malignant disease.
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Affiliation(s)
- Caroline E Franks
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jieli Li
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Magen Martinez
- TriCore Reference Laboratories, Albuquerque, NM, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Patricia M Jones
- Department of Pathology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, United States
| | | | - Qing H Meng
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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16
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Alsoussi WB, Malladi SK, Zhou JQ, Liu Z, Ying B, Kim W, Schmitz AJ, Lei T, Horvath SC, Sturtz AJ, McIntire KM, Evavold B, Han F, Scheaffer SM, Fox IF, Mirza SF, Parra-Rodriguez L, Nachbagauer R, Nestorova B, Chalkias S, Farnsworth CW, Klebert MK, Pusic I, Strnad BS, Middleton WD, Teefey SA, Whelan SPJ, Diamond MS, Paris R, O'Halloran JA, Presti RM, Turner JS, Ellebedy AH. SARS-CoV-2 Omicron boosting induces de novo B cell response in humans. Nature 2023; 617:592-598. [PMID: 37011668 DOI: 10.1038/s41586-023-06025-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
The primary two-dose SARS-CoV-2 mRNA vaccine series are strongly immunogenic in humans, but the emergence of highly infectious variants necessitated additional doses and the development of vaccines aimed at the new variants1-4. SARS-CoV-2 booster immunizations in humans primarily recruit pre-existing memory B cells5-9. However, it remains unclear whether the additional doses induce germinal centre reactions whereby re-engaged B cells can further mature, and whether variant-derived vaccines can elicit responses to variant-specific epitopes. Here we show that boosting with an mRNA vaccine against the original monovalent SARS-CoV-2 mRNA vaccine or the bivalent B.1.351 and B.1.617.2 (Beta/Delta) mRNA vaccine induced robust spike-specific germinal centre B cell responses in humans. The germinal centre response persisted for at least eight weeks, leading to significantly more mutated antigen-specific bone marrow plasma cell and memory B cell compartments. Spike-binding monoclonal antibodies derived from memory B cells isolated from individuals boosted with either the original SARS-CoV-2 spike protein, bivalent Beta/Delta vaccine or a monovalent Omicron BA.1-based vaccine predominantly recognized the original SARS-CoV-2 spike protein. Nonetheless, using a more targeted sorting approach, we isolated monoclonal antibodies that recognized the BA.1 spike protein but not the original SARS-CoV-2 spike protein from individuals who received the mRNA-1273.529 booster; these antibodies were less mutated and recognized novel epitopes within the spike protein, suggesting that they originated from naive B cells. Thus, SARS-CoV-2 booster immunizations in humans induce robust germinal centre B cell responses and can generate de novo B cell responses targeting variant-specific epitopes.
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Affiliation(s)
- Wafaa B Alsoussi
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Sameer Kumar Malladi
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Julian Q Zhou
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Zhuoming Liu
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, USA
| | - Baoling Ying
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, USA
| | - Wooseob Kim
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Aaron J Schmitz
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Tingting Lei
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Stephen C Horvath
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Alexandria J Sturtz
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Katherine M McIntire
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Birk Evavold
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Fangjie Han
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Suzanne M Scheaffer
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, USA
| | - Isabella F Fox
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Senaa F Mirza
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Luis Parra-Rodriguez
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Michael K Klebert
- Infectious Disease Clinical Research Unit, Washington University School of Medicine, St Louis, MO, USA
| | - Iskra Pusic
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Sean P J Whelan
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, USA
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, USA
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St Louis, MO, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St Louis, MO, USA
| | | | - Jane A O'Halloran
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
- Infectious Disease Clinical Research Unit, Washington University School of Medicine, St Louis, MO, USA
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
- Infectious Disease Clinical Research Unit, Washington University School of Medicine, St Louis, MO, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St Louis, MO, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St Louis, MO, USA
| | - Jackson S Turner
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
| | - Ali H Ellebedy
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St Louis, MO, USA.
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St Louis, MO, USA.
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Hughes AEO, Forbriger A, May AM, Scott MG, Char D, Farnsworth CW. Implementation of High-Sensitivity Troponin with a Rapid Diagnostic Algorithm Reduces Emergency Department Length of Stay for Discharged Patients. Clin Biochem 2023; 116:87-93. [PMID: 37054770 DOI: 10.1016/j.clinbiochem.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION High sensitivity troponin (hs-cTn) and diagnostic algorithms are used to rapidly triage patients with symptoms of acute myocardial infarction in emergency departments (ED). However, few studies have evaluated the impact of simultaneously implementing hs-cTn and a rapid rule-out algorithm on length of stay (LOS). METHODS We assessed the impact of transitioning from contemporary cTnI to hs-cTnI in 59,232 ED encounters over three years. hs-cTnI was implemented with an orderable series that included baseline, two-, four-, and six-hour specimens collected at provider discretion and operationalized with an algorithm to calculate the change in hs-cTnI from baseline and provide interpretations of "insignificant", "significant," or "equivocal." Patient demographics, results, chief complaint, disposition, and ED LOS were captured from the electronic medical record. RESULTS cTnI was ordered for 31,875 encounters prior to hs-cTnI implementation and 27,357 after. The proportion of cTnI results above the 99th percentile upper reference limit decreased from 35.0% to 27.0% for men and increased from 27.8% to 34.8% for women. Among discharged patients, the median LOS decreased by 0.6 h (0.5-0.7). LOS among discharged patients with a chief complaint of chest pain decreased by 1.0 h (0.8-1.1) and further decreased by 1.2 h (1.0-1.3) if the initial hs-cTnI was below the limit of quantitation. The rate of acute coronary syndrome upon re-presentation within 30 days did not change post-implementation (0.10% versus 0.07%). CONCLUSION Implementation of an hs-cTnI assay with a rapid rule-out algorithm decreased ED LOS among discharged patients, particularly among those with a chief complaint of chest pain.
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Affiliation(s)
- Andrew E O Hughes
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
| | - Arthur Forbriger
- Department of Emergency Medicine. Washington University School of Medicine. St. Louis, MO
| | - Adam M May
- Department of Medicine. Washington University School of Medicine. St. Louis, MO
| | - Mitchell G Scott
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
| | - Douglas Char
- Department of Emergency Medicine. Washington University School of Medicine. St. Louis, MO
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Omosule CL, Roper SM, Farnsworth CW. Frequency of Fentanyl Analogs and Metabolites Detected by LC-MS/MS in Clinical Specimens. J Appl Lab Med 2023; 8:428-430. [PMID: 36533488 DOI: 10.1093/jalm/jfac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Catherine L Omosule
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO
| | - Stephen M Roper
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
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19
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Farnsworth CW, Lyon OAS. QC a Risky Business: The Development of Novel Risk-Based Tools for Assessing QC Methods. J Appl Lab Med 2023; 8:3-6. [PMID: 36610412 DOI: 10.1093/jalm/jfac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Oliver A S Lyon
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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20
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Brown HM, Farnsworth CW, Bryan A, Genzen JR, Gronowski A, Philips Deeter J, Yarbrough M. One Bad Apple Can Spoil the Bunch: The Impact of Contamination in the Clinical Laboratory. Clin Chem 2023; 69:9-16. [PMID: 36449384 DOI: 10.1093/clinchem/hvac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Hannah Marie Brown
- Clinical Chemistry Fellow, Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Associate Professor, Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Andrew Bryan
- Assistant Professor, Assistant Director of Clinical Microbiology, Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan R Genzen
- Professor (Clinical), Department of Pathology, University of Utah Health and Chief Medical Officer, ARUP Laboratories, Salt Lake City, UT, USA
| | - Ann Gronowski
- Professor, Division Chief of Laboratory and Genomics Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jamie Philips Deeter
- Medical and Scientific Affairs, Roche Diagnostics Corporation, Indianapolis, IN, USA
| | - Melanie Yarbrough
- Associate Professor, Washington University in St. Louis, St. Louis, MO, USA.,Director of Clinical Microbiology, Barnes Jewish Hospital, St. Louis, MO, USA
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21
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Spies NC, Farnsworth CW, Jackups R. Data-Driven Anomaly Detection in Laboratory Medicine: Past, Present, and Future. J Appl Lab Med 2023; 8:162-179. [PMID: 36610428 DOI: 10.1093/jalm/jfac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Anomaly detection is an integral component of operating a clinical laboratory. It covers both the recognition of laboratory errors and the rapid reporting of clinically impactful results. Procedures for identifying laboratory errors and highlighting critical results can be improved by applying modern data-driven approaches. CONTENT This review will prepare the reader to appraise anomaly detection literature, identify common sources of anomalous results in the clinical laboratory, and offer potential solutions for common shortcomings in current laboratory practices. SUMMARY Laboratories should implement data-driven approaches to detect technical anomalies and keep them from entering the medical record, while also using the full array of clinical metadata available in the laboratory information system for context-dependent, patient-centered result interpretations.
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Affiliation(s)
- Nicholas C Spies
- Washington University Department of Pathology and Immunology, St. Louis, MO
| | | | - Ronald Jackups
- Washington University Department of Pathology and Immunology, St. Louis, MO
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22
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Alsoussi WB, Malladi SK, Zhou JQ, Liu Z, Ying B, Kim W, Schmitz AJ, Lei T, Horvath SC, Sturtz AJ, McIntire KM, Evavold B, Han F, Scheaffer SM, Fox IF, Parra-Rodriguez L, Nachbagauer R, Nestorova B, Chalkias S, Farnsworth CW, Klebert MK, Pusic I, Strnad BS, Middleton WD, Teefey SA, Whelan SP, Diamond MS, Paris R, O’Halloran JA, Presti RM, Turner JS, Ellebedy AH. SARS-CoV-2 Omicron boosting induces de novo B cell response in humans. bioRxiv 2022:2022.09.22.509040. [PMID: 36172127 PMCID: PMC9516848 DOI: 10.1101/2022.09.22.509040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The primary two-dose SARS-CoV-2 mRNA vaccine series are strongly immunogenic in humans, but the emergence of highly infectious variants necessitated additional doses of these vaccines and the development of new variant-derived ones 1-4 . SARS-CoV-2 booster immunizations in humans primarily recruit pre-existing memory B cells (MBCs) 5-9 . It remains unclear, however, whether the additional doses induce germinal centre (GC) reactions where reengaged B cells can further mature and whether variant-derived vaccines can elicit responses to novel epitopes specific to such variants. Here, we show that boosting with the original SARS- CoV-2 spike vaccine (mRNA-1273) or a B.1.351/B.1.617.2 (Beta/Delta) bivalent vaccine (mRNA-1273.213) induces robust spike-specific GC B cell responses in humans. The GC response persisted for at least eight weeks, leading to significantly more mutated antigen-specific MBC and bone marrow plasma cell compartments. Interrogation of MBC-derived spike-binding monoclonal antibodies (mAbs) isolated from individuals boosted with either mRNA-1273, mRNA-1273.213, or a monovalent Omicron BA.1-based vaccine (mRNA-1273.529) revealed a striking imprinting effect by the primary vaccination series, with all mAbs (n=769) recognizing the original SARS-CoV-2 spike protein. Nonetheless, using a more targeted approach, we isolated mAbs that recognized the spike protein of the SARS-CoV-2 Omicron (BA.1) but not the original SARS-CoV-2 spike from the mRNA-1273.529 boosted individuals. The latter mAbs were less mutated and recognized novel epitopes within the spike protein, suggesting a naïve B cell origin. Thus, SARS-CoV-2 boosting in humans induce robust GC B cell responses, and immunization with an antigenically distant spike can overcome the antigenic imprinting by the primary vaccination series.
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Affiliation(s)
- Wafaa B. Alsoussi
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- These authors contributed equally to this work
| | - Sameer K. Malladi
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- These authors contributed equally to this work
| | - Julian Q. Zhou
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- These authors contributed equally to this work
| | - Zhuoming Liu
- Department of Molecular Microbiology, Washington University School of Medicine; St. Louis, MO, USA
- These authors contributed equally to this work
| | - Baoling Ying
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine; St. Louis, MO, USA
- These authors contributed equally to this work
| | - Wooseob Kim
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Aaron J. Schmitz
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Tingting Lei
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Stephen C. Horvath
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Alexandria J. Sturtz
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Katherine M. McIntire
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Birk Evavold
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Fangjie Han
- Department of Emergency Medicine, Washington University School of Medicine; St. Louis, MO, USA
| | - Suzanne M. Scheaffer
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine; St. Louis, MO, USA
| | - Isabella F. Fox
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Luis Parra-Rodriguez
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine; St. Louis, MO, USA
| | | | | | | | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Michael K. Klebert
- Infectious Disease Clinical Research Unit, Washington University School of Medicine; St. Louis, MO, USA
| | - Iskra Pusic
- Division of Oncology, Department of Medicine, Washington University School of Medicine; St. Louis, MO, USA
| | - Benjamin S. Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine; St. Louis, MO, USA
| | - William D. Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine; St. Louis, MO, USA
| | - Sharlene A. Teefey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine; St. Louis, MO, USA
| | - Sean P.J. Whelan
- Department of Molecular Microbiology, Washington University School of Medicine; St. Louis, MO, USA
| | - Michael S. Diamond
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- Department of Molecular Microbiology, Washington University School of Medicine; St. Louis, MO, USA
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine; St. Louis, MO, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine; St. Louis, MO, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine; St. Louis, MO, USA
| | | | - Jane A. O’Halloran
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine; St. Louis, MO, USA
- Infectious Disease Clinical Research Unit, Washington University School of Medicine; St. Louis, MO, USA
| | - Rachel M. Presti
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine; St. Louis, MO, USA
- Infectious Disease Clinical Research Unit, Washington University School of Medicine; St. Louis, MO, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine; St. Louis, MO, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine; St. Louis, MO, USA
| | - Jackson S. Turner
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Ali H. Ellebedy
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine; St. Louis, MO, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine; St. Louis, MO, USA
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23
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Qavi AJ, Wu C, Lloyd M, Zaman MMU, Luan J, Ballman C, Leung DW, Crick SL, Farnsworth CW, Amarasinghe GK. Plasmonic Fluor-Enhanced Antigen Arrays for High-Throughput, Serological Studies of SARS-CoV-2. ACS Infect Dis 2022; 8:1468-1479. [PMID: 35867632 PMCID: PMC9344907 DOI: 10.1021/acsinfecdis.2c00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Serological testing for acute infection or prior exposure is critical for patient management and coordination of public health decisions during outbreaks. Current methods have several limitations, including variable performance, relatively low analytical and clinical sensitivity, and poor detection due to antigenic drift. Serological methods for SARS-CoV-2 detection for the ongoing COVID-19 pandemic suffer from several of these limitations and serves as a reminder of the critical need for new technologies. Here, we describe the use of ultrabright fluorescent reagents, Plasmonic Fluors, coupled with antigen arrays that address a subset of these limitations. We demonstrate its application using patient samples in SARS-CoV-2 serological assays. In our multiplexed assay, SARS-CoV-2 antigens were spotted into 48-plex arrays within a single well of a 96-well plate and used to evaluate remnant laboratory samples of SARS-CoV-2 positive patients. Signal-readout was performed with Auragent Bioscience's Empower microplate reader, and microarray analysis software. Sample volumes of 1 μL were used. High sensitivity of the Plasmonic Fluors combined with the array format enabled us to profile patient serological response to eight distinct SARS-CoV-2 antigens and evaluate responses to IgG, IgM, and IgA. Sensitivities for SARS-CoV-2 antigens during the symptomatic state ranged between 72.5 and 95.0%, specificity between 62.5 and 100%, and the resulting area under the curve values between 0.76 and 0.97. Together, these results highlight the increased sensitivity for low sample volumes and multiplex capability. These characteristics make Plasmonic Fluor-enhanced antigen arrays an attractive technology for serological studies for the COVID-19 pandemic and beyond.
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Affiliation(s)
- Abraham J. Qavi
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Chao Wu
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Matthew Lloyd
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | | | - Jingyi Luan
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Claire Ballman
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Daisy W. Leung
- Department
of Internal Medicine, Washington University
School of Medicine, St. Louis, Missouri 63110, United States
| | - Scott L. Crick
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Christopher W. Farnsworth
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Gaya K. Amarasinghe
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
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24
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Gandra S, Li T, Reske KA, Peacock K, Hock KG, Bommarito S, Miller C, Stewart H, Dang NL, Farnsworth CW, Olsen MA, Kwon JH, Warren DK, Fraser VJ. Longitudinal analysis of risk factors associated with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among hemodialysis patients and healthcare personnel in outpatient hemodialysis centers. Antimicrob Steward Healthc Epidemiol 2022; 2:e125. [PMID: 36483341 PMCID: PMC9726589 DOI: 10.1017/ash.2022.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 06/17/2023]
Abstract
In this prospective, longitudinal study, we examined the risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among a cohort of chronic hemodialysis (HD) patients and healthcare personnel (HCPs) over a 6-month period. The risk of SARS-CoV-2 infection among HD patients and HCPs was consistently associated with a household member having SARS-CoV-2 infection.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Tingting Li
- Division of Nephrology, Washington University School of Medicine, St Louis, Missouri
| | - Kimberly A. Reske
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Kate Peacock
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Karl G. Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Silvana Bommarito
- Division of Nephrology, Washington University School of Medicine, St Louis, Missouri
| | - Candace Miller
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Henry Stewart
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Na Le Dang
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
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25
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Azimi V, Jackups R, Farnsworth CW, Budelier MM. Use of laboratory data for illicit drug use surveillance and identification of socioeconomic risk factors. Drug Alcohol Depend 2022; 236:109499. [PMID: 35605528 DOI: 10.1016/j.drugalcdep.2022.109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug overdose is the leading cause of death among people 25-44 years of age in the United States. Existing drug surveillance methods are important for prevention and directing treatment, but are limited by delayed reporting and lack of geographic granularity. METHODS Laboratory urine drug screen and complete metabolic panel data from patients presenting to the emergency department was used to observe long-term and short-term temporal and geospatial changes at the zip code-level in St. Louis. Multivariate linear regression was performed to investigate associations between zip code-level socioeconomic factors and drug screening positivity rates. RESULTS An increase in the fentanyl positive drug screens was seen during the initial COVID-19 shutdown period in the spring of 2020. A decrease in cocaine positivity was seen in the fall and winter of 2020, with a return to baseline coinciding with the second major COVID-19 shutdown in the summer of 2021. These changes appeared to be independent of changes in emergency department utilization as measured by complete metabolic panels ordered. Significant short-term changes in fentanyl and cocaine positivity rates between specific time periods were able to be localized to individual zip codes. Zip code-level multivariate analysis demonstrated independent associations between socioeconomic/demographic factors and fentanyl/cocaine positivity rates as determined by laboratory drug screening data. CONCLUSIONS Analyzing clinical laboratory drug screening data can enable a more temporally and geographically granular view of population-level drug use surveillance. Additionally, laboratory data can be utilized to find population-level socioeconomic associations with illicit drug use, presenting a potential avenue for the use of this data to guide public health and healthcare policy decisions.
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Affiliation(s)
- Vahid Azimi
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ronald Jackups
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Melissa M Budelier
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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26
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Dhar A, Ballman C, Roemmich BL, Dubberke ER, Farnsworth CW. Serological detection of antibodies to the SARS-CoV-2 nucleocapsid protein from dried blood spots. Clin Biochem 2022; 108:67-68. [PMID: 35777486 PMCID: PMC9238023 DOI: 10.1016/j.clinbiochem.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Arko Dhar
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Claire Ballman
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Brittany L Roemmich
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Erik R Dubberke
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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27
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Bosserman RE, Farnsworth CW, O’Neil CA, Cass C, Park D, Ballman C, Wallace MA, Struttmann E, Stewart H, Arter O, Peacock K, Fraser VJ, Budge PJ, Olsen MA, Burnham CAD, Babcock HM, Kwon JH. Antibodies in healthcare personnel following severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection. Antimicrob Steward Healthc Epidemiol 2022; 2:e93. [PMID: 36483363 PMCID: PMC9726486 DOI: 10.1017/ash.2022.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 05/27/2023]
Abstract
In a prospective cohort of healthcare personnel (HCP), we measured severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) nucleocapsid IgG antibodies after SARS-CoV-2 infection. Among 79 HCP, 68 (86%) were seropositive 14-28 days after their positive PCR test, and 54 (77%) of 70 were seropositive at the 70-180-day follow-up. Many seropositive HCP (95%) experienced an antibody decline by the second visit.
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Affiliation(s)
- Rachel E. Bosserman
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Caroline A. O’Neil
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Candice Cass
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel Park
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Claire Ballman
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Emily Struttmann
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Henry Stewart
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Olivia Arter
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kate Peacock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Philip J. Budge
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Hilary M. Babcock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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28
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Mehta-Shah N, Bartlett NL, Kahl B, Watkins MP, Dubois A, Schmelzle G, Waqar S, Ballman C, Wan F, Farnsworth CW. COVID-19 booster vaccines generate seroconversion in subset of patients with lymphoma/CLL: single institution experience. Leuk Lymphoma 2022; 63:1723-1727. [DOI: 10.1080/10428194.2022.2038377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Neha Mehta-Shah
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Nancy L. Bartlett
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Brad Kahl
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Marcus P. Watkins
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Amalia Dubois
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gabby Schmelzle
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Saiama Waqar
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire Ballman
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Fei Wan
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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29
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Qavi AJ, Franks CE, Grajales-Reyes G, Anderson J, Ashby L, Zohner K, Gronowski AM, Farnsworth CW. Increased specimen minimum volume reduces turnaround time and hemolysis. Clin Biochem 2022; 115:137-143. [PMID: 35351449 DOI: 10.1016/j.clinbiochem.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
Quantity not sufficient (QNS) specimens with minimal blood volume for testing are common in clinical laboratories. However, there is no universal definition of minimum volume for a QNS specimen and little data is available addressing the impact of QNS / low volume specimens on turnaround time (TAT) and sample hemolysis. We compared the TAT and hemolysis index from samples ≤1.0 mL to all specimens received and quantified the number of specimens with reduced blood volume. A new QNS policy requiring ≥1.5 mL of sample in a blood tube for laboratory analysis was implemented and the results were assessed by sample hemolysis and TAT. The median laboratory TAT for samples with ≤1.0 mL of blood was 61 min (Interquartile Range, IQR: 50-82), in contrast to 28 min (26-34) for all samples. The hemolysis index for samples ≤1.0 mL was 112 (65-253) and 15 (8-29) for all samples. Requirement of a minimum volume of 1.5 mL of blood resulted in the proportion of samples with TAT ≥ 60 min to decrease from 10.4% to 4.24% in the ED, and for specimens cancelled due to hemolysis to decrease from 4.24% to 3.38%. This policy was introduced hospital wide with similar effects. Together, we correlate limited specimen volume with an increase in laboratory TAT and hemolysis. Implementation of a QNS policy of ≥1.5 mL and provider education provided a significant and durable reduction in TAT and specimen hemolysis.
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Affiliation(s)
- Abraham J Qavi
- Department of Pathology & Immunology, Washington University, School of Medicine, St. Louis, MO, United States
| | | | - Gary Grajales-Reyes
- Department of Pathology & Immunology, Washington University, School of Medicine, St. Louis, MO, United States
| | - Jeanne Anderson
- Department of Laboratories, Barnes Jewish Hospital, St. Louis, MO, United States
| | - Lori Ashby
- Department of Laboratories, Barnes Jewish Hospital, St. Louis, MO, United States
| | - Kimberly Zohner
- Department of Laboratories, Barnes Jewish Hospital, St. Louis, MO, United States
| | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University, School of Medicine, St. Louis, MO, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University, School of Medicine, St. Louis, MO, United States.
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30
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Li T, Gandra S, Reske KA, Olsen MA, Bommarito S, Miller C, Hock KG, Ballman CA, Su C, Le Dang N, Kwon JH, Warren DK, Fraser VJ, Farnsworth CW. Predictors of humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in patients receiving maintenance dialysis. Antimicrob Steward Healthc Epidemiol 2022; 2:e48. [PMID: 36310813 PMCID: PMC9615013 DOI: 10.1017/ash.2022.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 06/16/2023]
Abstract
Objective Patients on dialysis are at high risk for severe COVID-19 and associated morbidity and mortality. We examined the humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in a maintenance dialysis population. Design Single-center cohort study. Setting and participants Adult maintenance dialysis patients at 3 outpatient dialysis units of a large academic center. Methods Participants were vaccinated with 2 doses of BNT162b2, 3 weeks apart. We assessed anti-SARS-CoV-2 spike antibodies (anti-S) ∼4-7 weeks after the second dose and evaluated risk factors associated with insufficient response. Definitions of antibody response are as follows: nonresponse (anti-S level, <50 AU/mL), low response (anti-S level, 50-839 AU/mL), and sufficient response (anti-S level, ≥840 AU/mL). Results Among the 173 participants who received 2 vaccine doses, the median age was 60 years (range, 28-88), 53.2% were men, 85% were of Black race, 86% were on in-center hemodialysis and 14% were on peritoneal dialysis. Also, 7 participants (4%) had no response, 27 (15.6%) had a low response, and 139 (80.3%) had a sufficient antibody response. In multivariable analysis, factors significantly associated with insufficient antibody response included end-stage renal disease comorbidity index score ≥5 and absence of prior hepatitis B vaccination response. Conclusions Although most of our study participants seroconverted after 2 doses of BNT162b2, 20% of our cohort did not achieve sufficient humoral response. Our findings demonstrate the urgent need for a more effective vaccine strategy in this high-risk patient population and highlight the importance of ongoing preventative measures until protective immunity is achieved.
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Affiliation(s)
- Tingting Li
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A. Reske
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Silvana Bommarito
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Candace Miller
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Karl G. Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Claire A. Ballman
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Christina Su
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Na Le Dang
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - David K. Warren
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
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Amrute JM, Perry AM, Anand G, Cruchaga C, Hock KG, Farnsworth CW, Randolph GJ, Lavine KJ, Steed AL. Cell specific peripheral immune responses predict survival in critical COVID-19 patients. Nat Commun 2022; 13:882. [PMID: 35169146 PMCID: PMC8847593 DOI: 10.1038/s41467-022-28505-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 triggers a complex systemic immune response in circulating blood mononuclear cells. The relationship between immune cell activation of the peripheral compartment and survival in critical COVID-19 remains to be established. Here we use single-cell RNA sequencing and Cellular Indexing of Transcriptomes and Epitomes by sequence mapping to elucidate cell type specific transcriptional signatures that associate with and predict survival in critical COVID-19. Patients who survive infection display activation of antibody processing, early activation response, and cell cycle regulation pathways most prominent within B-, T-, and NK-cell subsets. We further leverage cell specific differential gene expression and machine learning to predict mortality using single cell transcriptomes. We identify interferon signaling and antigen presentation pathways within cDC2 cells, CD14 monocytes, and CD16 monocytes as predictors of mortality with 90% accuracy. Finally, we validate our findings in an independent transcriptomics dataset and provide a framework to elucidate mechanisms that promote survival in critically ill COVID-19 patients. Identifying prognostic indicators among critical COVID-19 patients holds tremendous value in risk stratification and clinical management.
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Affiliation(s)
- Junedh M Amrute
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Alexandra M Perry
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Gautam Anand
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Karl G Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Gwendalyn J Randolph
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Kory J Lavine
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ashley L Steed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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32
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Raju S, Tawiah KD, Farnsworth CW. A "Total" Interference. Clin Chem 2022; 68:372-373. [PMID: 36103295 DOI: 10.1093/clinchem/hvab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/19/2020] [Indexed: 04/06/2024]
Affiliation(s)
| | | | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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Cobb BL, Lloyd M, Hock KG, Farnsworth CW. OUP accepted manuscript. J Appl Lab Med 2022; 7:827-833. [PMID: 35296885 PMCID: PMC8992344 DOI: 10.1093/jalm/jfac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Background Serological assays for SARS-CoV-2 are important tools for diagnosis in patients with negative RT-PCR testing, pediatric patients with multisystem inflammatory syndrome, and serosurveillance studies. However, lateral flow-based serological assays have previously demonstrated poor analytical and clinical performance, limiting their utility. Methods We assessed the ADEXUSDx COVID-19 lateral flow assay for agreement with diagnostic RT-PCR testing using 120 specimens from RT-PCR–positive patients, 77 specimens from symptomatic RT-PCR–negative patients, and 47 specimens obtained prepandemic. Specimens collected <14 days from symptom onset in RT-PCR–positive patients were compared relative to the Abbott SARS-CoV-2 IgG assay. Results The ADEXUSDx COVID-19 Test yielded an overall positive percent agreement (PPA) of 92.5% (95%CI 85.8 to 96.3) and negative percent agreement of 99.2% (95% CI 94.9–100.0) relative to RT-PCR and in prepandemic specimens. Relative to days from symptom onset, the PPA after 13 days was 100% (95% CI 94.2–100); from 7 to 13 days, 89.7 (95% CI 71.5–97.2); and from 0 to 7 days, 53.8 (95% CI 26.1–79.6). The overall agreement between the Abbott and ADEXUSDx assays was 80.9%. Twenty-five specimens were positive by both assays, 9 specimens were negative by both assays, and 8 specimens were positive by only the ADEXUSDx assay. Conclusions We demonstrate high PPA and negative percent agreement of the ADEXUSDx COVID-19 assay and diagnostic testing by RT-PCR, with PPA approximately 90% by 7 days following symptom onset. The use of waived testing for antibodies to SARS-CoV-2 with high sensitivity and specificity provide a further tool for combatting the COVID-19 pandemic.
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Affiliation(s)
| | - Matthew Lloyd
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Karl G Hock
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Address correspondence to this author at: Department of Pathology & Immunology, Washington University in St. Louis, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO 63110, USA. Fax 314 362-1461; e-mail
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Wu C, Qavi AJ, Moyle AB, Wagner ND, Hachim A, Kavian N, Cole AR, Sweeney-Gibbons J, Rohrs HW, Peiris JM, Basler CF, Gross ML, Valkenburg SA, Farnsworth CW, Amarasinghe GK, Leung DW. Domain-specific biochemical and serological characterization of SARS-CoV-2 nucleocapsid protein. STAR Protoc 2021; 2:100906. [PMID: 34642671 PMCID: PMC8495048 DOI: 10.1016/j.xpro.2021.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nucleocapsid proteins are essential for SARS-CoV-2 life cycle. Here, we describe protocols to gather domain-specific insights about essential properties of nucleocapsids. These assays include dynamic light scattering to characterize oligomerization, fluorescence polarization to quantify RNA binding, hydrogen-deuterium exchange mass spectrometry to map RNA binding regions, negative-stain electron microscopy to visualize oligomeric species, interferon reporter assay to evaluate interferon signaling modulation, and a serology assay to reveal insights for improved sensitivity and specificity. These assays are broadly applicable to RNA-encapsidated nucleocapsids. For complete details on the use and execution of this protocol, please refer to Wu et al. (2021).
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Affiliation(s)
- Chao Wu
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Abraham J. Qavi
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Austin B. Moyle
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Nicole D. Wagner
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Asmaa Hachim
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Niloufar Kavian
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service d’Immunologie Biologique, Paris, France
- Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Aidan R. Cole
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Joyce Sweeney-Gibbons
- Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Henry W. Rohrs
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - J.S. Malik Peiris
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
- Division of Public Health Laboratory Sciences, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christopher F. Basler
- Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Michael L. Gross
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Sophie A. Valkenburg
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Gaya K. Amarasinghe
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Daisy W. Leung
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
- Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
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Farnsworth CW, Case JB, Hock K, Chen RE, O'Halloran JA, Presti R, Goss CW, Rauseo AM, Ellebedy A, Theel ES, Diamond MS, Henderson JP. Assessment of serological assays for identifying high titer convalescent plasma. Transfusion 2021; 61:2658-2667. [PMID: 34216156 PMCID: PMC8440373 DOI: 10.1111/trf.16580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been accompanied by the largest mobilization of therapeutic convalescent plasma (CCP) in over a century. Initial identification of high titer units was based on dose-response data using the Ortho VITROS IgG assay. The proliferation of severe acute respiratory syndrome coronavirus 2 serological assays and non-uniform application has led to uncertainty about their interrelationships. The purpose of this study was to establish correlations and analogous cutoffs between multiple serological assays. METHODS We compared the Ortho, Abbott, Roche, an anti-spike (S) ELISA, and a virus neutralization assay. Relationships relative to FDA-approved cutoffs under the CCP emergency use authorization were identified in convalescent plasma from a cohort of 79 donors from April 2020. RESULTS Relative to the neutralization assay, the spearman r value of the Ortho Clinical, Abbott, Roche, anti-S ELISA assays was 0.65, 0.59, 0.45, and 0.76, respectively. The best correlative index for establishing high-titer units was 3.87 signal-to-cutoff (S/C) for the Abbott, 13.82 cutoff index for the Roche, 1:1412 for the anti-S ELISA, 1:219 by the neutralization assay, and 15.9 S/C by the Ortho Clinical assay. The overall agreement using derived cutoffs compared to a neutralizing titer of 1:250 was 78.5% for Abbott, 74.7% for Roche, 83.5% for the anti-S ELISA, and 78.5% for Ortho Clinical. DISCUSSION Assays based on antibodies against the nucleoprotein were positively associated with neutralizing titers and the Ortho assay, although their ability to distinguish FDA high-titer specimens was imperfect. The resulting relationships help reconcile results from the large body of serological data generated during the COVID-19 pandemic.
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Affiliation(s)
| | - James B. Case
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Karl Hock
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Rita E. Chen
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Jane A. O'Halloran
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel Presti
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Charles W. Goss
- Division of Biostatistics, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Adriana M. Rauseo
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Ali Ellebedy
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Elitza S. Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Michael S. Diamond
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMissouriUSA
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Smith BK, Janowski AB, Fremont AC, Adams LJ, Dai YN, Farnsworth CW, Gronowski AM, Roper SM, Wang D, Fremont DH. Progression of SARS-CoV-2 Seroprevalence in St. Louis, Missouri, through January 2021. mSphere 2021; 6:e0045021. [PMID: 34346705 PMCID: PMC8386375 DOI: 10.1128/msphere.00450-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity was assessed for 3,066 individuals visiting hospitals in St. Louis, Missouri, during July 2020, November 2020, or January 2021. Seropositivity in children increased from 5.22% in July to 21.16% in January. In the same time frame, seropositivity among adults increased from 4.52% to 19.03%, prior to initiation of mass vaccination. IMPORTANCE This study determined the percentage of children and adult samples from the St. Louis metropolitan area in Missouri with SARS-CoV-2 antibodies during three collection periods spanning July 2020 to January 2021. By January 2021, 20.68% of the tested individuals had antibodies. These results show the evolution of the SARS-CoV-2 pandemic in St. Louis, Missouri, and provide a snapshot of the extent of infection just prior to the start of mass vaccination.
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Affiliation(s)
- Brittany K. Smith
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew B. Janowski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arim C. Fremont
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lucas J. Adams
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ya-Nan Dai
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher W. Farnsworth
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ann M. Gronowski
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen M. Roper
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Wang
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daved H. Fremont
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biochemistry & Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Schindler E, Dribus M, Duffy BF, Hock K, Farnsworth CW, Gragert L, Liu C. HLA genetic polymorphism in patients with Coronavirus Disease 2019 in Midwestern United States. HLA 2021; 98:370-379. [PMID: 34338446 PMCID: PMC8429120 DOI: 10.1111/tan.14387] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 12/21/2022]
Abstract
The experience of individuals with Coronavirus Disease 2019 (COVID‐19) ranges from asymptomatic to life threatening multi‐organ dysfunction. Specific HLA alleles may affect the predisposition to severe COVID‐19 because of their role in presenting viral peptides to launch the adaptive immune response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). In this population‐based case–control study in the midwestern United States, we performed high‐resolution HLA typing of 234 cases hospitalized for COVID‐19 in the St. Louis metropolitan area and compared their HLA allele frequencies with those of 22,000 matched controls from the National Marrow Donor Program (NMDP). We identified two predisposing alleles, HLA‐DRB1*08:02 in the Hispanic group (OR = 9.0, 95% confidence interval: 2.2–37.9; adjusted p = 0.03) and HLA‐A*30:02 in younger African Americans with ages below the median (OR = 2.2, 1.4–3.6; adjusted p = 0.01), and several candidate alleles with potential associations with COVID‐19 in African American, White, and Hispanic groups. We also detected risk‐associated amino acid residues in the peptide binding grooves of some of these alleles, suggesting the presence of functional associations. These findings support the notion that specific HLA alleles may be protective or predisposing factors to COVID‐19. Future consortium analysis of pooled cases and controls is warranted to validate and extend these findings, and correlation with viral peptide binding studies will provide additional evidence for the functional association between HLA alleles and COVID‐19.
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Affiliation(s)
- Emily Schindler
- Department of Laboratory Medicine, Mercy Hospital, St. Louis, Missouri, USA
| | - Marian Dribus
- Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian F Duffy
- HLA Laboratory, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Karl Hock
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher W Farnsworth
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Loren Gragert
- Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chang Liu
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Sharma A, Greene DN, Chambliss AB, Farnsworth CW, French D, Herman DS, Kavsak PA, Merrill AE, Margaret Lo SY, Lyon ME, Winston-McPherson G, Pearson LN, SoRelle JA, Waring AC, Schmidt RL. The effect of the Covid-19 shutdown on glycemic testing and control. Clin Chim Acta 2021; 519:148-152. [PMID: 33932408 PMCID: PMC8080532 DOI: 10.1016/j.cca.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic caused a halt to in-person ambulatory care. We evaluated how the reduction in access to care affected HbA1c testing and patient HbA1c levels. METHODS HbA1c data from 11 institutions were extracted to compare testing volume and the percentage of abnormal results between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (Jan-June 2020, period 2). HbA1c results greater than 6.4% were categorized as abnormal. RESULTS HbA1C testing volumes decreased in March, April and May by 23, 61 and 40% relative to the corresponding months in 2019. The percentage of abnormal results increased in April, May and June (25, 23, 9%). On average, we found that the frequency of abnormal results increased by 0.31% for every 1% decrease in testing volume (p < 0.0005). CONCLUSION HbA1c testing volume for outpatients decreased by up to 70% during the early months of the pandemic. The decrease in testing was associated with an increase in abnormal HbA1c results.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Dina N Greene
- Kaiser Permanente Washington, Renton, WA, United States
| | - Allison B Chambliss
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Daniel S Herman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Lauren N Pearson
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT
| | | | | | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT.
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39
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Pearson LN, Johnson SA, Greene DN, Chambliss AB, Farnsworth CW, French D, Herman DS, Kavsak PA, Merrill AE, Lo SYM, Lyon ME, SoRelle JA, Schmidt RL. Side-Effects of COVID-19 on Patient Care: An INR Story. J Appl Lab Med 2021; 6:953-961. [PMID: 33760097 PMCID: PMC8083676 DOI: 10.1093/jalm/jfab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/15/2021] [Indexed: 01/07/2023]
Abstract
Background Numerous studies have documented reduced access to patient care due to the COVID-19 pandemic including access to a diagnostic or screening tests, prescription medications, and treatment for an ongoing condition. In the context of clinical management for venous thromboembolism, this could result in suboptimal therapy with warfarin. We aimed to determine the impact of the pandemic on utilization of International normalized ratio (INR) testing and the percentage of high and low results. Methods INR data from 11 institutions were extracted to compare testing volume and the percentage of INR results ≥3.5 and ≤1.5 between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (January-June 2020, period 2). The analysis was performed for inpatient and outpatient cohorts. Results Testing volumes showed relatively little change in January and February, followed by a significant decrease in March, April and May, and then returned to baseline in June. Outpatient testing showed a larger percentage decrease in testing volume compared to inpatient testing. At 10 of the 11 study sites we observed an increase in the percentage of abnormal high INR results as test volumes decreased, primarily among outpatients. Conclusion The COVID-19 pandemic impacted INR testing among outpatients which may be attributable to several factors. Increased supratherapeutic INR results during the pandemic period when there was reduced laboratory utilization and access to care is concerning because of the risk of adverse bleeding events in this group of patients. This could be mitigated in the future by offering drive through testing and/or widespread implementation of home INR monitoring.
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Affiliation(s)
- Lauren N Pearson
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Stacy A Johnson
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dina N Greene
- Kaiser Permanente Washington, Washington, Renton, WA, USA
| | - Allison B Chambliss
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Deborah French
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel S Herman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, CA, USA
| | - Jeffrey A SoRelle
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
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40
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Tawiah KD, Hock KG, Farnsworth CW. Limited Diagnostic Utility of SARS-CoV-2 Serologic Testing in Symptomatic PCR Negative Patients. J Appl Lab Med 2021; 6:1083-1085. [PMID: 33749743 PMCID: PMC8083762 DOI: 10.1093/jalm/jfab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Kwaku D Tawiah
- Department of Pathology and Immunology, Washington University in St. Louis, MO
| | - Karl G Hock
- Department of Pathology and Immunology, Washington University in St. Louis, MO
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41
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Tang MS, Case JB, Franks CE, Chen RE, Anderson NW, Henderson JP, Diamond MS, Gronowski AM, Farnsworth CW. Association between SARS-CoV-2 Neutralizing Antibodies and Commercial Serological Assays. Clin Chem 2021; 66:1538-1547. [PMID: 32894750 PMCID: PMC7499494 DOI: 10.1093/clinchem/hvaa211] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Introduction Commercially available SARS-CoV-2 serological assays based on different viral antigens have been approved for the qualitative determination of anti-SARS-CoV-2 antibodies. However, there are limited published data associating the results from commercial assays with neutralizing antibodies. Methods 67 specimens from 48 patients with PCR-confirmed COVID-19 and a positive result by the Roche Elecsys Anti-SARS-CoV-2, Abbott SARS-CoV-2 IgG, or EUROIMMUN SARS-CoV-2 IgG assays and 5 control specimens were analyzed for the presence of neutralizing antibodies to SARS-CoV-2. Correlation, concordance, positive percent agreement (PPA), and negative percent agreement (NPA) were calculated at several cutoffs. Results were compared in patients categorized by clinical outcomes. Results The correlation between SARS-CoV-2 neutralizing titer (EC50) and the Roche, Abbott, and EUROIMMUN assays was 0.29, 0.47, and 0.46 respectively. At an EC50 of 1:32, the concordance kappa with Roche was 0.49 (95% CI; 0.23-0.75), with Abbott was 0.52 (0.28-0.77), and with EUROIMMUN was 0.61 (0.4-0.82). At the same neutralizing titer, the PPA and NPA for the Roche was 100% (94-100) & 56% (30-80); Abbott was 96% (88-99) & 69% (44-86); and EUROIMMUN was 91% (80-96) & 81% (57-93) for distinguishing neutralizing antibodies. Patients who were intubated, had cardiac injury, or acute kidney injury from COVID-19 infection had higher neutralizing titers relative to those with mild symptoms. Conclusion COVID-19 patients generate an antibody response to multiple viral proteins such that the calibrator ratios on the Roche, Abbott, and EUROIMMUN assays are all associated with SARS-CoV-2 neutralization. Nevertheless, commercial serological assays have poor NPA for SARS-CoV-2 neutralization, making them imperfect proxies for neutralization.
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Affiliation(s)
- Mei San Tang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - James Brett Case
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Caroline E Franks
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Rita E Chen
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey P Henderson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.,Department of Medicine, Washington University School of Medicine, St. Louis, MO.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO
| | - Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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42
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Tang MS, Lloyd M, Williams M, Farnsworth CW, Budelier MM. Performance Evaluation of an Automated Fentanyl Immunoassay. J Appl Lab Med 2021; 6:1192-1201. [PMID: 34263303 DOI: 10.1093/jalm/jfab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/05/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND High-throughput fentanyl immunoassays have recently emerged for clinical use, but early reports have demonstrated relatively high false-positive rates. The purpose of this study was to compare 2 immunoassays, the ARK and ARK II fentanyl immunoassays, and to demonstrate the clinical impact of implementing the ARK II assay. METHODS The ARK and ARK II fentanyl assays were performed on a Roche c 502 chemistry analyzer. Positive and negative percentage agreement was assessed for each assay with 112 residual patient specimens relative to liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cross-reactivity was assessed with the primary metabolite, norfentanyl, and analogs acetylfentanyl, acrylfentanyl, and furanylfentanyl. The proportion of specimens that did not confirm was assessed retrospectively from the laboratory information system. RESULTS The concordance of the ARK assay was 75% (kappa 0.46, 95%CI 0.28-0.63) and the ARK II was 93% (kappa 0.86, 95%CI 0.76-0.95) with LC-MS/MS. 30 ng/mL of norfentanyl was required for a positive result by ARK and 15 ng/mL by ARK II. Similar cross-reactivity was observed when fentanyl and norfentanyl were both present in the specimen and with fentanyl analogs. After implementing the ARK II assay, the proportion of specimens that did not confirm by LC-MS/MS decreased from 11.7% per month to 2.0% per month. CONCLUSIONS The ARK II fentanyl immunoassay has improved concordance relative to the original ARK fentanyl immunoassay using LC-MS/MS as the comparator method. Improved analyte specificity resulted in a reduced proportion of clinical samples that do not confirm. Impact StatementHigh-throughput fentanyl immunoassays are available for clinical use, but the false-positive rate is relatively high at ∼10%-14%. Here we assess the ARK II fentanyl immunoassay and demonstrate better concordance relative to mass spectrometry than the original ARK assay. Clinical implementation of the ARK II assay led to a reduction in samples that were falsely positive from 11.7% using the ARK assay to 2.0%. Improvements to the original ARK fentanyl assay are likely to reduce false-positive fentanyl screens and reduce unnecessary confirmatory assays.
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Affiliation(s)
- Mei San Tang
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine., St. Louis, MO
| | - Matthew Lloyd
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine., St. Louis, MO.,Department of Laboratories, Barnes Jewish Hospital, St. Louis, MO
| | - Monette Williams
- Department of Laboratories, Barnes Jewish Hospital, St. Louis, MO
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine., St. Louis, MO
| | - Melissa M Budelier
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine., St. Louis, MO
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43
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Wu C, Qavi AJ, Hachim A, Kavian N, Cole AR, Moyle AB, Wagner ND, Sweeney-Gibbons J, Rohrs HW, Gross ML, Peiris JSM, Basler CF, Farnsworth CW, Valkenburg SA, Amarasinghe GK, Leung DW. Characterization of SARS-CoV-2 nucleocapsid protein reveals multiple functional consequences of the C-terminal domain. iScience 2021; 24:102681. [PMID: 34095780 PMCID: PMC8168301 DOI: 10.1016/j.isci.2021.102681] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/13/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
Nucleocapsid (N) encoded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays key roles in the replication cycle and is a critical serological marker. Here, we characterize essential biochemical properties of N and describe the utility of these insights in serological studies. We define N domains important for oligomerization and RNA binding and show that N oligomerization provides a high-affinity RNA-binding platform. We also map the RNA-binding interface, showing protection in the N-terminal domain and linker region. In addition, phosphorylation causes reduction of RNA binding and redistribution of N from liquid droplets to loose coils, showing how N-RNA accessibility and assembly may be regulated by phosphorylation. Finally, we find that the C-terminal domain of N is the most immunogenic, based on antibody binding to patient samples. Together, we provide a biochemical description of SARS-CoV-2 N and highlight the value of using N domains as highly specific and sensitive diagnostic markers.
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Affiliation(s)
- Chao Wu
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Abraham J. Qavi
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Asmaa Hachim
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Niloufar Kavian
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service d’Immunologie Biologique, Paris, France
- Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Aidan R. Cole
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Austin B. Moyle
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - Nicole D. Wagner
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - Joyce Sweeney-Gibbons
- Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Henry W. Rohrs
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael L. Gross
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - J. S. Malik Peiris
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
- Division of Public Health Laboratory Sciences, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christopher F. Basler
- Center for Microbial Pathogenesis, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sophie A. Valkenburg
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Gaya K. Amarasinghe
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daisy W. Leung
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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44
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Gandra S, Li T, Reske KA, Dang NL, Farnsworth CW, Hock KG, Miller C, Olsen MA, Kwon JH, Warren DK, Fraser VJ. SARS-CoV-2 Infection Risk Factors among Maintenance Hemodialysis Patients and Health Care Personnel In Outpatient Hemodialysis Centers. Kidney360 2021; 2:996-1001. [PMID: 35373088 PMCID: PMC8791360 DOI: 10.34067/kid.0001282021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/16/2021] [Indexed: 01/06/2023]
Abstract
Increased risk of SARS-CoV-2 infection was associated with community prevalence.Increased risk of SARS-CoV-2 infection was associated with exposure to infected family members and personal infection prevention measures.
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45
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Farnsworth CW, Logsdon NM, Hayes JE, Rais R, Willrich MA, Gronowski AM. Limitations of Free Light Chain Assays caused by the Matrix Effect. J Appl Lab Med 2021; 5:311-319. [PMID: 32445382 DOI: 10.1093/jalm/jfz021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/01/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Serum free light chain (FLC) assays are used clinically to measure the concentration of κ and λ FLC in patients with suspected or diagnosed plasma cell proliferative disorders. Previous studies have demonstrated a loss of linearity in low concentration ranges of these assays. We hypothesized that this result could be caused by a matrix effect. METHODS Recovery studies were performed for κ and λ FLC in both serum and saline using the Freelite assay (Binding Site) on a Cobas c502 system (Roche). Samples were analyzed either at the recommended dilution or undiluted. Follow-up studies were performed in varying matrices ranging from 0% to 100% saline. Retrospective patient data were analyzed to assess the impact on reported κ FLC, λ FLC, and κ/λ ratio. RESULTS FLC in a serum matrix demonstrated underrecovery relative to samples diluted in saline for both κ and λ FLC. Of 255 patient samples with λ FLC measured undiluted (λ FLC <6.0 mg/L), an unexpected gap was observed in patient results between 2.0 and 6.0 mg/L. In addition, 23 patients measured serially with λ FLC between 2.0 and 6.0 mg/L demonstrated dramatic changes in κ/λ ratio, with no changes in κ FLC, likely because of the matrix effect. CONCLUSIONS The κ and λ Freelite assays exhibit a matrix effect when samples are tested undiluted, which has the potential to affect the κ/λ ratio. Consequently, our laboratory has stopped reporting λ FLC <6.0 mg/L.
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Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | | | | | - Rehan Rais
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Maria A Willrich
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ann M Gronowski
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
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46
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Farnsworth CW, Dietzen DJ, Roper SM. Atypical Findings on a Urine Organic Acid Profile. J Appl Lab Med 2021; 5:388-393. [PMID: 32445368 DOI: 10.1093/jalm/jfz002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Dennis J Dietzen
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Stephen M Roper
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
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47
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Tawiah KD, Farnsworth CW. Genomics-Guided Contact Tracing: Tool for the Future or for Today? Clin Chem 2021; 66:1362. [PMID: 33001194 DOI: 10.1093/clinchem/hvaa194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Kwaku D Tawiah
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
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48
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Tang MS, Farnsworth CW. Associating SARS-CoV-2 Serological Assays with Protection: Where the Field Stands. Clin Chem 2021; 67:707-709. [PMID: 33772260 PMCID: PMC8083671 DOI: 10.1093/clinchem/hvab039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Mei San Tang
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
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49
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Orner EP, Rodgers MA, Hock K, Tang MS, Taylor R, Gardiner M, Olivo A, Fox A, Prostko J, Cloherty G, Farnsworth CW. Comparison of SARS-CoV-2 IgM and IgG seroconversion profiles among hospitalized patients in two US cities. Diagn Microbiol Infect Dis 2021; 99:115300. [PMID: 33388575 PMCID: PMC7759125 DOI: 10.1016/j.diagmicrobio.2020.115300] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
The clinical and public health utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic testing requires a better understanding of the dynamics of the humoral response to infection. To track seroconversion of IgG and IgM antibodies in patients with SARS-CoV-2 infection and its association with patient and clinical factors and outcomes. Residual patient specimens were analyzed on the Abbott ARCHITECT i2000 instrument using the Abbott SARS-CoV-2 IgG assay and prototype SARS-CoV-2 IgM assay. Age, sex, comorbidities, symptom onset date, mortality, and specimen collection date were obtained from electronic medical records. Three hundred fifty-nine longitudinal samples were collected from 89 hospitalized patients 0 to 82 days postsymptom onset. Of all, 51.7% of the patients developed IgG and IgM antibodies simultaneously; 32.8% seroconverted for IgM before IgG. On average, patients seroconverted for IgG by 8 days and for IgM by 7 days postsymptom onset. All patients achieved IgG seropositivity by 19 days and IgM seropositivity by 17 days. Median time to IgG and IgM seroconversion was prolonged and initial levels of IgG were lower in immunocompromised patients and patients <65 years of age compared to immune competent patients and those ≥65 years of age. Immunocompromised patients also had persistently lower levels of IgM that peaked on day 17.6 and decreased thereafter compared to immune competent patients. IgM seroconversion in patients who died reached significantly higher levels later after symptom onset than in those who recovered. SARS-CoV-2 infected patients have similar time to seroconversion for IgG and IgM. However, differences in immune status and age alter time to seroconversion. These results may help guide serologic testing application in COVID-19 management.
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Affiliation(s)
- Erika P Orner
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Karl Hock
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | - Mei San Tang
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | | | | | | | - Amy Fox
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA.
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50
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Farnsworth CW, Wallace MA, Liu A, Gronowski AM, Burnham CAD, Yarbrough ML. Evaluation of the Risk of Laboratory Microbial Contamination during Routine Testing in Automated Clinical Chemistry and Microbiology Laboratories. Clin Chem 2021; 66:1190-1199. [PMID: 32870987 DOI: 10.1093/clinchem/hvaa128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Every clinical specimen is potentially infectious, but data regarding risk for contamination of the laboratory environment during routine testing are scarce. We assessed contamination during routine sample analysis in automated clinical chemistry and microbiology laboratories. METHODS A fluorescent marker was applied to specimen container exteriors to assess the impact of gross contamination. Nonpathogenic MS2 virus was added to remnant blood, urine, and ESwab matrices as a biomarker of cross-contamination. Samples were processed and analyzed using Roche Cobas 8100 and ISE, c502, e602, and c702 modules (blood) and BD Kiestra total laboratory automation (blood, urine, ESwabs) over 3 experiments. Fluorescence transfer to laboratory surfaces and personnel was visualized using ultraviolet light. Surfaces were swabbed and assessed for MS2 cross-contamination by RT-PCR. Adherence to standard precautions by laboratory staff was assessed by observation. RESULTS Fluorescence was observed on 49 of 165 (30%) laboratory surfaces and personnel and 21 of 93 (23%) total laboratory automation instruments. Fluorescence transferred most frequently to gloves (31/40), computer accessories (9/18), and specimen loading racks (12/12). None of 123 areas swabbed were positive for MS2. Improper personal protective equipment use occurred at a rate of 0.36 and 0.15 events per staff per hour in the chemistry and microbiology laboratories, respectively. Hand-washing compliance was observed for 61 of 132 (46%) staff members evaluated. CONCLUSIONS Analysis of grossly contaminated specimens on automated chemistry and microbiology equipment elicits a low likelihood of instrument contamination. However, handling contaminated specimen containers can result in contamination of environmental laboratory surfaces, representing a source of risk that is heightened by low adherence to appropriate personal protective equipment.
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Affiliation(s)
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Albert Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melanie L Yarbrough
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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