Shojaei Maryam, Chen Uan-I, Midic Uros, Thair Simone, Teoh Sally, McLean Anthony, Sweeney Timothy E, Thompson Matthew, Liesenfeld Oliver, Khatri Purvesh, Tang Benjamin
Department of Medicine, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia.
Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia.
Eur J Clin Invest. 2023 May;53(5):e13957. doi: 10.1111/eci.13957. Epub 2023 Feb 8.
Indiscriminate use of antimicrobials and antimicrobial resistance is a public health threat. IMX-BVN-1, a 29-host mRNA classifier, provides two separate scores that predict likelihoods of bacterial and viral infections in patients with suspected acute infections. We validated the performance of IMX-BVN-1 in adults attending acute health care settings with suspected influenza.
We amplified 29-host response genes in RNA extracted from blood by NanoString nCounter. IMX-BVN-1 calculated two scores to predict probabilities of bacterial and viral infections. Results were compared against the infection status (no infection; highly probable/possible infection; confirmed infection) determined by clinical adjudication.
Amongst 602 adult patients (74.9% ED, 16.9% ICU, 8.1% outpatients), 7.6% showed in-hospital mortality and 15.5% immunosuppression. Median IMX-BVN-1 bacterial and viral scores were higher in patients with confirmed bacterial (0.27) and viral (0.62) infections than in those without bacterial (0.08) or viral (0.21) infection, respectively. The AUROC distinguishing bacterial from nonbacterial illness was 0.81 and 0.87 when distinguishing viral from nonviral illness. The bacterial top quartile's positive likelihood ratio (LR) was 4.38 with a rule-in specificity of 88%; the bacterial bottom quartile's negative LR was 0.13 with a rule-out sensitivity of 96%. Similarly, the viral top quartile showed an infinite LR with rule-in specificity of 100%; the viral bottom quartile had a LR of 0.22 and a rule-out sensitivity of 85%.
IMX-BVN-1 showed high accuracy for differentiating bacterial and viral infections from noninfectious illness in patients with suspected influenza. Clinical utility of IMX-BVN will be validated following integration into a point of care system.
抗菌药物的滥用以及抗菌药物耐药性是对公众健康的一种威胁。IMX-BVN-1是一种包含29种宿主的mRNA分类器，可提供两个独立的评分，用于预测疑似急性感染患者发生细菌和病毒感染的可能性。我们在疑似流感的急性医疗环境中的成人患者中验证了IMX-BVN-1的性能。
我们通过NanoString nCounter对从血液中提取的RNA中的29种宿主反应基因进行扩增。IMX-BVN-1计算两个评分以预测细菌和病毒感染的概率。将结果与通过临床判定确定的感染状态（无感染；极有可能/可能感染；确诊感染）进行比较。
在602名成年患者中（74.9%为急诊科患者，16.9%为重症监护病房患者，8.1%为门诊患者），7.6%出现院内死亡，15.5%出现免疫抑制。确诊细菌感染（0.27）和病毒感染（0.62）的患者中IMX-BVN-1的细菌和病毒评分中位数分别高于无细菌感染（0.08）或病毒感染（0.21）的患者。区分细菌性疾病和非细菌性疾病时的曲线下面积（AUROC）为0.81，区分病毒性疾病和非病毒性疾病时为0.87。细菌评分最高四分位数的阳性似然比（LR）为4.38，纳入规则的特异性为88%；细菌评分最低四分位数的阴性LR为0.13，排除规则的敏感性为96%。同样，病毒评分最高四分位数的LR无穷大，纳入规则的特异性为100%；病毒评分最低四分位数的LR为0.22，排除规则的敏感性为85%。
IMX-BVN-1在疑似流感患者中区分细菌和病毒感染与非感染性疾病方面显示出高准确性。IMX-BVN的临床实用性将在整合到即时护理系统后得到验证。
