Validation of a host response test to distinguish bacterial and viral respiratory infection.

Lydon, Emily C

Henao, Ricardo

Burke, Thomas W

Aydin, Mert

Nicholson, Bradly P

Glickman, Seth W

Fowler, Vance G

Quackenbush, Eugenia B

Cairns, Charles B

Kingsmore, Stephen F

Jaehne, Anja K

Rivers, Emanuel P

Langley, Raymond J

Petzold, Elizabeth

Ko, Emily R

McClain, Micah T

Ginsburg, Geoffrey S

Woods, Christopher W

Tsalik, Ephraim L

2019-11-01T15:05:03Z

2019-11-01T15:05:03Z

2019-10-17

2019-11-01T15:05:02Z

BACKGROUND:Distinguishing bacterial and viral respiratory infections is challenging. Novel diagnostics based on differential host gene expression patterns are promising but have not been translated to a clinical platform nor extensively tested. Here, we validate a microarray-derived host response signature and explore performance in microbiology-negative and coinfection cases. METHODS:Subjects with acute respiratory illness were enrolled in participating emergency departments. Reference standard was an adjudicated diagnosis of bacterial infection, viral infection, both, or neither. An 87-transcript signature for distinguishing bacterial, viral, and noninfectious illness was measured from peripheral blood using RT-PCR. Performance characteristics were evaluated in subjects with confirmed bacterial, viral, or noninfectious illness. Subjects with bacterial-viral coinfection and microbiologically-negative suspected bacterial infection were also evaluated. Performance was compared to procalcitonin. FINDINGS:151 subjects with microbiologically confirmed, single-etiology illness were tested, yielding AUROCs 0•85-0•89 for bacterial, viral, and noninfectious illness. Accuracy was similar to procalcitonin (88% vs 83%, p = 0•23) for bacterial vs. non-bacterial infection. Whereas procalcitonin cannot distinguish viral from non-infectious illness, the RT-PCR test had 81% accuracy in making this determination. Bacterial-viral coinfection was subdivided. Among 19 subjects with bacterial superinfection, the RT-PCR test identified 95% as bacterial, compared to 68% with procalcitonin (p = 0•13). Among 12 subjects with bacterial infection superimposed on chronic viral infection, the RT-PCR test identified 83% as bacterial, identical to procalcitonin. 39 subjects had suspected bacterial infection; the RT-PCR test identified bacterial infection more frequently than procalcitonin (82% vs 64%, p = 0•02). INTERPRETATION:The RT-PCR test offered similar diagnostic performance to procalcitonin in some subgroups but offered better discrimination in others such as viral vs. non-infectious illness and bacterial/viral coinfection. Gene expression-based tests could impact decision-making for acute respiratory illness as well as a growing number of other infectious and non-infectious diseases.

S2352-3964(19)30644-9

2352-3964

2352-3964

https://hdl.handle.net/10161/19461

eng

Elsevier BV

EBioMedicine

10.1016/j.ebiom.2019.09.040

Biomarkers

Coinfection

Diagnosis

Gene expression

Precision medicine

Respiratory tract infections

Validation of a host response test to distinguish bacterial and viral respiratory infection.

Journal article

Henao, Ricardo|0000-0003-4980-845X

Burke, Thomas W|0000-0003-0592-5822

Fowler, Vance G|0000-0002-8048-0897

Ginsburg, Geoffrey S|0000-0003-4739-9808

Woods, Christopher W|0000-0001-7240-2453

Tsalik, Ephraim L|0000-0002-6417-2042

School of Medicine

Duke

Nursing

School of Nursing

Duke Cancer Institute

Institutes and Centers

Pathology

Clinical Science Departments

Medicine, Cardiology

Medicine

Duke Global Health Institute

University Institutes and Centers

Institutes and Provost's Academic Units

Medicine, Infectious Diseases

Molecular Genetics and Microbiology

Basic Science Departments

Published