Utility of immune response-derived biomarkers in the differential diagnosis of inflammatory disorders

A host-protein signature is superior to other biomarkers for differentiating between bacterial and viral disease in patients with respiratory infection and fever without source: a prospective observational study

“…[19] in its head-to-head comparison to classical and other (e.g., HNL) biomarkers and to prediction rules, its detailed analysis of performance across specific pathogens and its estimation of the potential for this new diagnostic tool to reduce antibiotic use in two clinical syndromes that are challenging for the clinician to manage. The biomarkers and prediction rules in this comparative study were selected based either on the breadth of their current clinical use and/or their potential for application in real clinical settings for discriminating between bacterial and viral respiratory infections and fever without source [6,7]. We did not examine nucleic acid panels as, although several research studies support promising performance for differentiating between bacterial and viral infections [16][17][18], currently there are no affordable technologies for measuring multiple RNAs in a quantitative manner in under an hour, restricting application of nucleic acid biomarkers at point-of-care.…”

“…Host biomarkers hold great promise as routine diagnostic tools as this approach can overcome many of the previously described challenges [ 6 , 7 ]. Multiple candidates have been documented, including traditional cellular markers (e.g., white blood cell count, WBC [ 2 ] and absolute neutrophil count, ANC [ 8 ]) and soluble host-proteins, both classical (e.g., interleukin-6, IL-6 [ 9 ]; C-reactive protein, CRP [ 2 , 10 – 12 ]; and procalcitonin, PCT [ 2 , 10 , 12 – 14 ]) and others (e.g., human neutrophil lipocalin, HNL/NGAL [ 15 ]).…”

Validation of a Novel Assay to Distinguish Bacterial and Viral Infections

“…8,9 Host-based biomarker approaches represent a promising complement to pathogen-based diagnostics. 10 In recent studies, authors examining host-RNA signatures in response to different infections show promising results. 11 -16 However, quantitative and rapid measurement (within minutes) of multiple host RNAs remains a technical challenge, particularly at the point of need.…”

Diagnostic accuracy of a TRAIL, IP-10 and CRP combination for discriminating bacterial and viral etiologies at the Emergency Department

“…A major challenge underlying effective management of febrile ED patients is the difficulty in clinically distinguishing between bacterial and viral etiologies highlighted by ten Oever et al 1 This clinical uncertainty drives antibiotic misuse, both underuse and overuse, with detrimental ramifications for the patient, healthcare system and society, including emergence of antibiotic resistance. While routine diagnostic tests for pathogen detection may aid in determining infection etiology, they often are limited by one or more of the following key limitations: (i) lengthy time to result; (ii) inability to diagnose infections that are not readily accessible (e.g., pneumonia); (iii) uncertainty regarding the clinical interpretation of a viral identification, which does not preclude the possibility of a bacterial co-infection; and (iv) false alarms due to the presence ("carriage") of potentially pathogenic microbes that are also part of the natural flora (e.g., Streptococcus pneumoniae).…”