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Evaluation of a potential novel biomarker & derivation of clinical prediction rules for severe influenza in emergency department patients.

机译：对急诊科患者中严重流感的潜在新生物标志物的评估和临床预测规则的推导。

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摘要

Background. Diagnosis of the etiologic agent of respiratory viral infection traditionally relies on culture or antigen detection. A novel platform, the mass spectrometry followed RT-PCR (RT-PCR/ESI-MS), which has capability to rapidly identify and quantify multiple pathogens simultaneously, were evaluated in this study. Disposition decision making for patients with influenza can be problematic in emergency departments (ED). Influenza Viral load (VL), which has been shown to be important for many pathogens, has been proposed as a predictor of symptom severity, inpatient length of stay, and clinical course, and could be utilized in ED. A clinical prediction rule (CPR), in order to aid clinicians to prediction VL in overcrowded ED, was derived in this study. Another CPR to help clinicians to stratify the need for hospitalization for patients with influenza, incorporating influenza VL and other clinical information, was derived as well.;Method. The RT-PCR/ESI-MS respiratory virus surveillance kit was designed to detect seven including influenza. Excess frozen archived nasopharyngeal aspirates (NPA) from patients visited ED during 2007-8 respiratory season (N=192) were analyzed by RT-PCR/ESI-MS then compared to clinical virology results to assess "qualitative" performance. Dilution series of Influenza A (H3N2) were spiked into different media (viral transport media and negative NPA) to assess the "quantitative" performance (accuracy and reliability) of RT-PCR/ESI-MS platform. Another retrospective cohort of patients with laboratory confirmed influenza from EDs (N=117) in 2007-2009 was consented to derive CPRs by recursive partitioning algorithm with influenza VL obtained by PCR/ESI-MS.;Results. RT-PCR/ESI-MS has moderately well performance of qualification (sensitivity: 89.1%, specificity: 80.3%) and quantification (range of reliable quantification: 3.2x105--6.4x10 5 genome copies/mL, R2: 0.88-0.99, rho: 0.87-0.95). CPR for VL prediction contains age with six different cutoff points, vaccination history, and absolute neutrophil count (c-statistics: 0.85, sensitivity: 90%, specificity: 83%). CPR for hospitalization prediction contains underlying illness, age, influenza VL level, and vaccination history (c-statistics: 0.84, sensitivity: 76%, specificity: 83%).;Conclusion. RT-PCR/ESI-MS demonstrated capacity to rapidly and multiply detects respiratory viruses with good performance of qualification and quantification. CPR for VL and hospitalization were derived and merits further validation for use in ED disposition decision-making for patients with influenza.
机译：背景。呼吸道病毒感染的病原学诊断通常依靠培养物或抗原检测。在这项研究中，评估了一种新颖的平台，其后的质谱是基于RT-PCR（RT-PCR / ESI-MS）的，该平台具有快速识别和定量多种病原体的能力。在急诊科中，对流感患者的处置决策可能会出现问题。流感病毒载量（VL）已被证明对许多病原体都很重要，已被提议作为症状严重程度，住院天数和临床病程的预测指标，可用于急诊科。为了帮助临床医生预测过度拥挤的ED中的VL，制定了临床预测规则（CPR）。还得出了另一项帮助临床医生将流感VL和其他临床信息结合在一起的，可帮助临床医生对流感患者进行住院治疗的分层策略。 RT-PCR / ESI-MS呼吸道病毒监视试剂盒旨在检测包括流感在内的7种病毒。通过RT-PCR / ESI-MS分析了2007-8呼吸季节（ED = 192）在急诊科就诊的急诊鼻咽吸入物（NPA）的数量，并与临床病毒学结果进行了比较，以评估“定性”的表现。将稀释的甲型流感（H3N2）系列掺入不同的介质（病毒运输介质和NPA阴性）中，以评估RT-PCR / ESI-MS平台的“定量”性能（准确性和可靠性）。另一项回顾性队列研究是在2007-2009年间对由EDs（N = 117）实验室确诊的流感患者进行的回顾性研究，他们同意通过递归分配算法结合PCR / ESI-MS获得的VL来获得CPR。 RT-PCR / ESI-MS在鉴定（灵敏度：89.1％，特异性：80.3％）和定量（可靠定量范围：3.2x105--6.4x10 5个基因组拷贝/ mL，R2：0.88-0.99， rho：0.87-0.95）。用于VL预测的CPR包含具有六个不同的临界点的年龄，疫苗接种史和中性粒细胞绝对计数（c统计量：0.85，敏感性：90％，特异性：83％）。用于住院预测的CPR包含潜在疾病，年龄，流感VL水平和疫苗接种史（c统计量：0.84，敏感性：76％，特异性：83％）。 RT-PCR / ESI-MS具有快速鉴定和鉴定和定量检测呼吸道病毒的能力。得出了VL的CPR和住院治疗，值得进一步验证，可用于流感患者的ED处理决策。

著录项

  • 作者

    Chen, Kuan-Fu.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Biology Biostatistics.;Health Sciences Medicine and Surgery.;Biology Virology.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 154 p.
  • 总页数 154
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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