Potential Application of Novel Host Immune Signature in SARS-CoV-2 Positive Patient Management at the Emergency Department
2infectious Dis, Hhillel Yaffe Medical Center
3Faculty of Medicine, Ruth and Bruce Rappaport Faculty of Medicine , Technion
4Diagnostics, Me-Med Diagnostics
Background: Direct polymerase Chain Reaction (PCR) testing for SARS-CoV-2 is an essential test in an outbreak however, it suffers several limitations including: (i) in case of outbreak prolongation viral evolution may occur, potentially reducing performance and (ii) requires viral load levels that may sometimes lead to inconclusive results. The National Institute of Health (NIH) suggests a classification of COVID-19 positive patients into 5 categories: Asymptomatic, Mild, Moderate, Severe and Critical.1 A majority of COVID-19 patients are classified as mild.2
MeMed BV™ is a host-immune signature comprising the measurement of TNF-related apoptosis inducing ligand (TRAIL), Interferon gamma related protein 10 (IP-10), and C-reactive protein (CRP), the levels of which are integrated into a score. A score 65 indicates a bacterial immune response (including co-infection). The signature has been demonstrated to accurately differentiate bacterial from viral infections in multiple clinical studies, across various pathogens.3,4,5 Here we asked whether MeMed BV™ shows similar performance in mild PCR confirmed SARS-CoV-2 patients.
Methods: Twenty-seven SARS-CoV-2 positive patients that arrived to the ED and were classified as mild COVID-19 were included in the analysis: 51.9% were male, 4 were pediatric patients ranging in age from 3months to 17 years, median age of the 23 adults was 58 (IQR 25.5) and median time from symptom onset to emergency department (ED) presentation was 1.4 days (IQR 2.1). These data were collected retrospectively as part of the Spirit study at Hillel Yaffe Medical Center.
Results: Of the 27 SARS-CoV-2 positive patients classified as mild upon arrival to the ED (Figure 1), our preliminary data demonstrate that in 19 (70.4%) a viral host immune response was elicited as indicated by a MeMed BV™ score of65 indicating a bacterial immune response and were assessed by the treating physician as bacterial, and 5 received an equivocal score (35 ≤ MeMed BV™ ≤ 65). All 4 pediatric patients received a MeMed BV™ score
Conclusions: MeMed BV™ deployment in the ED may help identify SARS-CoV-2 positive patients with a bacterial co-infection. A technology able to measure MeMed BV™ within 15 minutes is available. Additional research is warranted.
Figure 1: Study Cohort
References
1. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed December 31st, 2020.
2. Wu, Zunyou, and Jennifer M. McGoogan. "Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention." Jama 323, no. 13 (2020): 1239-1242.
3. Oved K, Cohen A, Boico O, et al. A novel host-proteome signature for distinguishing between acute bacterial and viral infections. PLoS One 2015; 10: e0120012.
4. van Houten CB, de Groot JAH, Klein A, et al. A host-protein based assay to differentiate between bacterial and viral infections in preschool children (OPPORTUNITY): a double-blind, multicentre, validation study. Lancet Infect Dis. 2017;17(4):431–440.
5. Srugo I, Klein A, Stein M, et al. Validation of a novel assay to distinguish bacterial and viral infections. Pediatrics 2017;140:e20163453.