Host Biomarkers Reflect Prognosis in Patients Presenting With Moderate Coronavirus Disease 2019: A Prospective Cohort Study

Chandna, Arjun; Mahajan, Raman; Gautam, Priyanka; Mwandigha, Lazaro; Kumar, Pragya; Varghese, George; Koshiaris, Constantinos; Lubell, Yoel; Burza, Sakib

doi:10.1093/ofid/ofac526

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…As McDonald et al note, the results of hospital-based studies cannot be generalised to community settings; in our study, most children (71.6%; 644/900) were managed in the community and only a quarter (26.2%; 236/900) had severe pneumonia at presentation, compared to over three-quarters of children who had severe pneumonia at the time sTREM-1 levels were measured in previous hospital-based studies 19 , 20 . Furthermore, studies of adults with Covid-19 suggest that sTREM-1 may be useful for predicting mortality but less well-suited for predicting proximal outcomes such as supplemental oxygen requirement 54 , 55 .…”

Section: Discussionmentioning

confidence: 99%

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Chandna

Lubell

Mwandigha

et al. 2023

Sci Rep

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Reliable tools to inform outpatient management of childhood pneumonia in resource-limited settings are needed. We investigated the value added by biomarkers of the host infection response to the performance of the Liverpool quick Sequential Organ Failure Assessment score (LqSOFA), for triage of children presenting with pneumonia to a primary care clinic in a refugee camp on the Thailand-Myanmar border. 900 consecutive presentations of children aged ≤ 24 months meeting WHO pneumonia criteria were included. The primary outcome was receipt of supplemental oxygen. We compared discrimination of a clinical risk score (LqSOFA) to markers of endothelial injury (Ang-1, Ang-2, sFlt-1), immune activation (CHI3L1, IP-10, IL-1ra, IL-6, IL-8, IL-10, sTNFR-1, sTREM-1), and inflammation (CRP, PCT), and quantified the net benefit of including biomarkers alongside LqSOFA. We evaluated the differential contribution of LqSOFA and host biomarkers to the diagnosis and prognosis of pneumonia severity. 49/900 (5.4%) presentations met the primary outcome. Discrimination of LqSOFA and Ang-2, the best performing biomarker, were comparable (AUC 0.82 [95% CI 0.76–0.88] and 0.81 [95% CI 0.74–0.87] respectively). Combining Ang-2 with LqSOFA improved discrimination (AUC 0.91; 95% CI 0.87–0.94; p < 0.001), and resulted in greater net benefit, with 10–30% fewer children who required oxygen supplementation incorrectly identified as safe for community-based management. Ang-2 had greater prognostic utility than LqSOFA to identify children requiring supplemental oxygen later in their illness course. Combining Ang-2 and LqSOFA could guide referrals of childhood pneumonia from resource-limited community settings. Further work on test development and integration into patient triage is required.

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Section: Discussionmentioning

confidence: 99%

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Chandna

Lubell

Mwandigha

et al. 2023

Sci Rep

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“…17,18 Furthermore, studies of adults with Covid-19 suggest that sTREM-1 may be useful for predicting mortality but less well-suited for predicting proximal outcomes such as supplemental oxygen requirement. 43,44 This is the largest study investigating the role of markers of endothelial injury and immune activation in paediatric pneumonia, and the only study to our knowledge conducted at the community-level. The local circumstances of our cohort enabled us to recruit children at the first point of contact with the formal health system and follow-up those managed as outpatients, aspects that are critical for robust evaluation of clinical scores and biomarkers in primary care.…”

Section: Discussionmentioning

confidence: 99%

Defining the role of host biomarkers in the diagnosis and prognosis of childhood pneumonia – a prospective cohort study

Chandna

Lubell

Mwandigha

et al. 2022

Preprint

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Background Reliable tools to inform outpatient management of childhood pneumonia in resource-limited settings are needed. We investigated the value added by biomarkers of host infection response to the performance of the Liverpool quick Sequential Organ Failure Assessment score (LqSOFA), for triage of children presenting with pneumonia to a primary care clinic in a refugee camp on the Thailand-Myanmar border. Methods 900 presentations of children aged ≤ 24 months meeting WHO pneumonia criteria were included. The primary outcome was receipt of supplemental oxygen. We compared discrimination of a clinical risk score (LqSOFA) to markers of endothelial injury (Ang-1, Ang-2, sFlt-1), immune activation (CHI3L1, IP-10, IL-1ra, IL-6, IL-8, IL-10, sTNFR-1, sTREM-1), and inflammation (CRP, PCT), and quantified the net-benefit of including biomarkers alongside LqSOFA. We evaluated the differential contribution of LqSOFA and host biomarkers to the diagnosis and prognosis of severe pneumonia. Results 49/900 (5.4%) presentations met the primary outcome. Discrimination of LqSOFA and Ang-2, the best performing biomarker, were comparable (AUC 0.82 [95% CI 0.76-0.88] and 0.81 [95% CI 0.74-0.87] respectively). Combining Ang-2 with LqSOFA improved discrimination (AUC 0.91; 95% CI 0.87-0.94; p < 0.001), and resulted in greater net-benefit, with 10-30% fewer children requiring oxygen supplementation incorrectly identified as safe for community-based management. Ang-2 had greater prognostic utility than LqSOFA to identify children requiring supplemental oxygen later in their illness course. Conclusions Combining Ang-2 and LqSOFA could guide referrals of childhood pneumonia from resource-limited community settings. Further work on integration into patient triage is required.

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“…Point-of-care testing (POCT) revolutionizes diagnostics by providing rapid results, particularly effective in resourcelimited settings. Studies show POCT's efficacy in diagnosing infectious diseases and diabetes, leading to faster treatment initiation [11]. Public-private partnerships (PPPs) bolster diagnostic access through collaborations between governments, private sector entities, and non-governmental organizations (NGOs), enhancing infrastructure and coverage, ultimately improving health outcomes [12].…”

Section: Introductionmentioning

confidence: 99%

Situational Analysis of Healthcare and Medical Diagnostic Testing Facility Availability in Selected Blocks of Muzaffarpur District, Bihar, India: A Cross-Sectional Study

Kumar,

Ahmad,

Kumar

et al. 2023

Cureus

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Introduction: This study presents a comprehensive assessment of healthcare facilities, focusing on workforce composition, operational dynamics, diagnostic laboratory services, and accessibility considerations. The comparison between government and private healthcare sectors provides insights into service delivery and potential disparities. The study's rationale, objectives, and methodology are explored in the context of the Indian healthcare landscape. Methods: A cross-sectional analysis was conducted in Muzaffarpur district, Bihar, targeting selected urban and rural blocks. The study employed geolocation data to analyze accessibility to healthcare facilities. Data collection involved on-site visits, structured questionnaires, and consultation of the Indian Council of Medical Research (ICMR)'s framework. The assessment concentrated on the availability of tests offered by the LaBike platform, and workforce compositions were compared.Results: Government healthcare facilities exhibited a balanced distribution of doctors, nurses, and grassroot workers, reflecting comprehensive healthcare provisions. Private facilities, although featuring moderate doctor and nurse presence, lacked grassroot workers. Diagnostic test prevalence was evident, with core tests, such as CBC and blood glucose, available in over 85% of facilities. Government facilities provided tests free of charge, while private facilities showcased a diverse cost spectrum. Proposed interventions received strong support from both sectors, indicating the potential for innovative healthcare solutions.Accessibility analysis: Urban intervention and control sites demonstrated comparable accessibility, with facilities located within 2 km. In rural intervention and control sites, distances varied significantly. Mushahari, a rural intervention site, required participants to travel 6 km to the nearest facility, impacting healthcare access. By contrast, Marwan, a rural control site, featured a shorter distance of 3 km.Conclusion: This study's comprehensive evaluation of healthcare facilities offers valuable insights into workforce dynamics, diagnostic services, and healthcare interventions in the context of government and private sectors. The findings underscore the significance of addressing workforce gaps and promoting equitable access to diagnostics. By informing evidence-based decision-making, this study contributes to the optimization of healthcare service delivery, aiming to enhance healthcare quality and accessibility for all.

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Host Biomarkers Reflect Prognosis in Patients Presenting With Moderate Coronavirus Disease 2019: A Prospective Cohort Study

Cited by 4 publications

References 22 publications

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Defining the role of host biomarkers in the diagnosis and prognosis of childhood pneumonia – a prospective cohort study

Situational Analysis of Healthcare and Medical Diagnostic Testing Facility Availability in Selected Blocks of Muzaffarpur District, Bihar, India: A Cross-Sectional Study

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