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A comparison of host response strategies to distinguish bacterial and viral infection.

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Date
2021-01
Authors
Ross, Melissa
Henao, Ricardo
Burke, Thomas W
Ko, Emily R
McClain, Micah T
Ginsburg, Geoffrey S
Woods, Christopher W
Tsalik, Ephraim L
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Abstract
<h4>Objectives</h4>Compare three host response strategies to distinguish bacterial and viral etiologies of acute respiratory illness (ARI).<h4>Methods</h4>In this observational cohort study, procalcitonin, a 3-protein panel (CRP, IP-10, TRAIL), and a host gene expression mRNA panel were measured in 286 subjects with ARI from four emergency departments. Multinomial logistic regression and leave-one-out cross validation were used to evaluate the protein and mRNA tests.<h4>Results</h4>The mRNA panel performed better than alternative strategies to identify bacterial infection: AUC 0.93 vs. 0.83 for the protein panel and 0.84 for procalcitonin (P<0.02 for each comparison). This corresponded to a sensitivity and specificity of 92% and 83% for the mRNA panel, 81% and 73% for the protein panel, and 68% and 87% for procalcitonin, respectively. A model utilizing all three strategies was the same as mRNA alone. For the diagnosis of viral infection, the AUC was 0.93 for mRNA and 0.84 for the protein panel (p<0.05). This corresponded to a sensitivity and specificity of 89% and 82% for the mRNA panel, and 85% and 62% for the protein panel, respectively.<h4>Conclusions</h4>A gene expression signature was the most accurate host response strategy for classifying subjects with bacterial, viral, or non-infectious ARI.
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Journal article
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https://hdl.handle.net/10161/24292
Published Version (Please cite this version)
10.1371/journal.pone.0261385
Publication Info
Ross, Melissa; Henao, Ricardo; Burke, Thomas W; Ko, Emily R; McClain, Micah T; Ginsburg, Geoffrey S; ... Tsalik, Ephraim L (2021). A comparison of host response strategies to distinguish bacterial and viral infection. PloS one, 16(12). pp. e0261385. 10.1371/journal.pone.0261385. Retrieved from https://hdl.handle.net/10161/24292.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Ginsburg

Geoffrey Steven Ginsburg

Adjunct Professor in the Department of Medicine
Dr. Geoffrey S. Ginsburg's research interests are in the development of novel paradigms for developing and translating genomic information into medical practice and the integration of personalized medicine into health care.
Henao

Ricardo Henao

Associate Professor in Biostatistics & Bioinformatics
McClain

Micah Thomas McClain

Associate Professor of Medicine
Tsalik

Ephraim Tsalik

Adjunct Associate Professor in the Department of Medicine
My research at Duke has focused on understanding the dynamic between host and pathogen so as to discover and develop host-response markers that can diagnose and predict health and disease.  This new and evolving approach to diagnosing illness has the potential to significantly impact individual as well as public health considering the rise of antibiotic resistance. With any potential infectious disease diagnosis, it is difficult, if not impossible, to determine at the time of pre
Woods

Christopher Wildrick Woods

Professor of Medicine
1. Emerging Infections 2. Global Health 3. Epidemiology of infectious diseases 4. Clinical microbiology and diagnostics 5. Bioterrorism Preparedness 6. Surveillance for communicable diseases 7. Antimicrobial resistance
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