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- Title
Expression of TRAIL, IP-10, and CRP in children with suspected COVID-19 and real-life impact of a computational signature on clinical decision-making: a prospective cohort study.
- Authors
Fröhlich, Franziska; Gronwald, Benjamin; Bay, Johannes; Simon, Arne; Poryo, Martin; Geisel, Jürgen; Tegethoff, Sina A.; Last, Katharina; Rissland, Jürgen; Smola, Sigrun; Becker, Sören L.; Zemlin, Michael; Meyer, Sascha; Papan, Cihan
- Abstract
Purpose: We evaluated the host-response marker score "BV" and its components TRAIL, IP-10, and CRP in SARS-CoV-2 positive children, and estimated the potential impact on clinical decision-making. Methods: We prospectively analyzed levels of TRAIL, IP-10, CRP, and the BV score, in children with suspected COVID-19. Classification of infectious etiology was performed by an expert panel. We used a 5-point-questionnaire to evaluate the intention to treat with antibiotics before and after receiving test results. Results: We screened 111 children, of whom 6 (5.4%) were positive for SARS-CoV-2. A total of 53 children were included for the exploratory analysis. Median age was 3.1 years (interquartile range [IQR] 1.3–4.3), and 54.7% (n = 29) were girls. A viral and a bacterial biomarker pattern was found in 27/53 (50.9%) and 15/53 (28.3%), respectively. BV scores differed between COVID-19, children with other viral infections, and children with bacterial infections (medians 29.5 vs. 9 vs. 66; p = 0.0006). Similarly, median TRAIL levels were different (65.5 vs. 110 vs. 78; p = 0.037). We found no differences in IP-10 levels (555 vs. 504 vs. 285; p = 0.22). We found a concordance between physicians' "unlikely intention to treat" children with a viral test result in most cases (n = 19/24, 79.2%). When physicians expressed a "likely intention to treat" (n = 15), BV test revealed 5 bacterial, viral, and equivocal scores each. Antibiotics were withheld in three cases (20%). Overall, 27/42 (64%) of pediatricians appraised the BV test positively, and considered it helpful in clinical practice. Conclusion: Host-response based categorization of infectious diseases might help to overcome diagnostic uncertainty, support clinical decision-making and reduce unnecessary antibiotic treatment.
- Subjects
DIAGNOSIS of bacterial diseases; PROTEIN analysis; ANTIBIOTICS; VIRAL disease diagnosis; C-reactive protein; BIOMARKERS; COVID-19; COMMUNICABLE diseases; UNCERTAINTY; UNNECESSARY surgery; DECISION making; QUESTIONNAIRES; DESCRIPTIVE statistics; RESEARCH funding; CHEMOKINES; DECISION making in clinical medicine; TERMINATION of treatment; PHYSICIANS; INTENTION; MEDICAL practice; CARRIER proteins; LONGITUDINAL method; CHILDREN
- Publication
Infection, 2023, Vol 51, Issue 5, p1349
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-023-01993-1