宿主蛋白生物阵列区分细菌和非细菌来源提供相似的诊断免疫抑制患者呈现ED脓毒症

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-08-16 DOI:10.1016/j.jemermed.2025.04.041

D Robinson , M Sheraton , N Sepulveda , J Boyle , A Kane , J Furbacher , M Vu , D Ticas , B Karfunkle , C Bakunas , C Gardiner

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引用次数: 0

摘要

背景免疫抑制（ISD）患者向急诊科（EDs）提出的脓毒症的未知病因需要广泛的检查。快速免疫分析法（MeMedBV©，（BV））测量tnf相关的凋亡诱导配体（TRAIL）、干扰素γ诱导蛋白10 （IP-10）、c反应蛋白（CRP）和专有的“BV评分”用于区分脓毒症来源（细菌与非细菌），但尚不清楚它是否对ISD患者有用。方法通过病例对照，比较MeMedBV©对脓毒症患者的诊断反应。细菌或非细菌感染的明确诊断是通过血液培养，实验室和x线摄影裁定。将所有ISD和免疫功能正常（ICT）受试者的BV评分和个体蛋白水平制成表格。使用非参数Kruskal-Wallis检验的比较分析评估了ISD组和ICT组之间的诊断准确性。原假设是，与ICT组相比，ISD组败血症患者的BV和宿主蛋白评分相似。结果13例细菌性病因患者，ISD与ICT的BV评分比较，h统计值为0.95，p值为0.33，TRAIL: h统计值；3.17， p值0.07，CRP: h统计值；1.84， p值0.17，IP-10为h统计量；3.23， p值为0.07。在非细菌组（n=6）， BV评分比较结果为h统计；0.03， p值为0.87，TRAIL: h统计量；0.01， p值0.94，CRP: h统计；0.24， p值0.62，IP-10为h统计量；0.11， p值0.74。因此，ISD组和ICT组之间BV评分和宿主蛋白没有显著差异。结论免疫抑制组和免疫正常组的宿主3蛋白生物阵列和BV评分相似。因此，测量宿主蛋白反应的快速诊断测试可能有助于区分细菌和非细菌感染来源，尽管存在ISD状态。建议进一步研究更大的样本量和各种原因的ISD，以完善临床诊断性能。

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Host Protein Bio-Array Distinguishing Bacterial and Non-Bacterial Sources Provides Similar Diagnostics in Immunosuppressed Patients Presenting to the ED with Sepsis

Background

Immunosuppressed (ISD) patients presenting to emergency departments (EDs) with sepsis concerns of unknown etiology require a broad work-up. A rapid immunoassay (MeMedBV©, (BV)) which measures TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), C-reactive protein (CRP), and a proprietary ‘BV score’ are used to distinguish sepsis source (bacterial versus non-bacterial) but is unclear whether it is useful in ISD patients.

Methods

A case-controlled series comparing the diagnostic response of MeMedBV© on ISD subjects presenting with sepsis physiology. A definitive diagnosis of bacterial or non-bacterial infection was adjudicated through blood cultures, laboratory, and radiography. The BV scores and individual protein levels were tabulated for all ISD and immunocompetent (ICT) subjects. Comparison analysis using the non-parametric Kruskal-Wallis test assessed diagnostic accuracy between the ISD and ICT groups. The null hypothesis was that the BV and host protein scores are similar in the ISD compared to the ICT group in patients presenting with sepsis.

Results

For patients with bacterial etiology (n=13), the BV score comparison between ISD and ICT resulted in an H-statistic of 0.95 with a p-value of 0.33, TRAIL: H-statistic; 3.17, p-value 0.07, CRP: H-statistic; 1.84, p-value 0.17, and IP-10: H-statistic; 3.23, p-value of 0.07. In the non-bacterial group (n=6), the BV score comparison resulted in an H-statistic; 0.03, p-value of 0.87, TRAIL: H-statistic; 0.01, p-value 0.94, CRP: H-statistic; 0.24, p-value 0.62, and IP-10: H-statistic; 0.11, p-value 0.74. Thus, no significant differences of BV scores or host proteins were reported between ISD and ICT groups.

Conclusion

This host 3-protein bio-array and BV score performed similarly in both immunosuppressed and immunocompetent groups. A rapid diagnostic test measuring host protein response may therefore be useful in distinguishing bacterial and non-bacterial sources of infection despite ISD status. Further studies with larger sample sizes and various causes of ISD are recommended to refine diagnostic performance in clinical settings.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine