Evaluation of the host immune response assay SeptiCyte RAPID for potential triage of COVID-19 patients.

Tools for the evaluation of COVID-19 severity would help clinicians with triage decisions, especially the decision whether to admit to ICU. The aim of this study was to evaluate SeptiCyte RAPID, a host immune response assay (Immunexpress, Seattle USA) as a triaging tool for COVID-19 patients requiring hospitalization and potentially ICU care. SeptiCyte RAPID employs a host gene expression signature consisting of the ratio of expression levels of two immune related mRNAs, PLA2G7 and PLAC8, measured from whole blood samples. Blood samples from 146 adult SARS-CoV-2 (+) patients were collected within 48 h of hospital admission in PAXgene blood RNA tubes at Hospital del Mar, Barcelona, Spain, between July 28th and December 1st, 2020. Data on demographics, vital signs, clinical chemistry parameters, radiology, interventions, and SeptiCyte RAPID were collected and analyzed with bioinformatics methods. The performance of SeptiCyte RAPID for COVID-19 severity assessment and ICU admission was evaluated, relative to the comparator of retrospective clinical assessment by the Hospital del Mar clinical care team. In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity: critical vs. mild (AUC = 0.93, p < 0.0001), critical vs. moderate (AUC = 0.77, p = 0.002), severe vs. mild (AUC = 0.85, p = 0.0003), severe vs. moderate (AUC = 0.63, p = 0.05). This discrimination was significantly better (by AUC or p-value) than could be achieved by CRP, lactate, creatine, IL-6, or D-dimer. Some of the critical or severe cases had "early" blood draws (before ICU admission; n = 33). For these cases, when compared to moderate and mild cases not in ICU (n = 37), SeptiCyte RAPID had AUC = 0.78 (p = 0.00012). In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity as defined by the WHO COVID-19 Clinical Management Living Guidance of January 25th, 2021. Measurements taken early (before a patient is considered for ICU admission) suggest that high SeptiScores could aid in predicting the need for later ICU admission.

Comparison of Hospitalized Coronavirus Disease 2019 and Influenza Patients Requiring Supplemental Oxygen in a Cohort Study: Clinical Impact and Resource Consumption.

BACKGROUND: To compare clinical characteristics, outcomes, and resource consumption of patients with coronavirus disease 2019 (COVID-19) and seasonal influenza requiring supplemental oxygen. METHODS: Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted because of seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. RESULTS: COVID-19 cases were younger (median years of age, 67; interquartile range [IQR] 54-78 vs 76 [IQR 64-83]; P < .001) and more frequently overweight, whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory, and renal disease. Compared with influenza, COVID-19 cases had more pneumonia (98% vs 60%, <.001), higher Modified Early Warning Score (MEWS) and CURB-65 (confusion, blood urea nitrogen, respiratory rate, systolic blood pressure, and age >65 years) scores and were more likely to show worse progression on the World Health Organization ordinal scale (33% vs 4%; P < .001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (P = .001). The median age of nonsurviving cases was 81 (IQR 74-88) and 77.5 (IQR 65-84) (P = .385), respectively. COVID-19 was independently associated with 30-day (hazard ratio [HR], 4.6; 95% confidence interval [CI], 2-10.4) and 90-day (HR, 5.2; 95% CI, 2.4-11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. CONCLUSIONS: Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes.

COMPARACIÓN DE MÉTODOS CONVENCIONALES Y MOLECULARES PARA LA DETECCIÓN DE Giardia lamblia EN HECES HUMANAS / COMPARISON OF CONVENTIONAL AND MOLECULAR METHODS FOR DETECTION OF Giardia lamblia IN HUMAN FEACES

Los protozoarios del género Giardia representan algunos de los parásitos humanos más comunes en el mundo y están entre los principales causantes de infecciones gastrointestinales y enfermedades diarreicas en humanos. La detección del parásito se fundamenta generalmente en los métodos por concentración y microscopía convencional, pero estas técnicas presentan limitaciones por su baja sensibilidad e inespecificidad en el diagnóstico. En procura de mejorar los métodos de diagnóstico, las técnicas moleculares se perfilan como una alternativa promisoria. En este estudio se analizaron 88 muestras de heces provenientes de pacientes de una empresa prestadora de servicios de salud (ASSBASALUD) de la ciudad de Manizales (Caldas). Para la detección de Giardia lamblia en heces se compararon tres métodos diferentes por medio del porcentaje de positividad: los métodos convencionales de concentración de la muestra y observación microscópica, análisis por inmunoensayo (ELISA indirecto) y finalmente la amplificación de dos secuencias génicas nucleares por PCR. Se obtuvieron tres muestras positivas por concentración y microscopía convencional, dos por inmunoensayo y 26 por técnicas moleculares. El estudio sugiere que las pruebas diagnósticas rutinarias basadas en microscopía convencional e inmunoensayo, tienen más bajo porcentaje de detección de este parásito y que esta deficiencia puede ser compensada por medio de la implementación de métodos de diagnóstico molecular basados en PCR, como una estrategia complementaria de apoyo en el diagnóstico de este protozoo.

The protozoa of the genus Giardia represent one of the most common human parasites in the world and are among the main causes of gastrointestinal infections and diarrheal diseases in humans. Parasite detection is generally based on concentration and conventional microscopy methods, but these techniques have limitations due to their low sensitivity and specificity in diagnosis. In an attempt to improve the diagnostic methods, molecular techniques are emerging as a promising alternative. In this study 88 stool samples from patients of a company that provides health services (ASSBASALUD) in the city of Manizales (Caldas) were analyzed. In order to detect Giardia lamblia in stool, three different methods were compared using the positivity percent: conventional methods for concentration of the sample and microscopic observation, analysis by immunoassay (indirect ELISA) and finally the amplification of two nuclear gene sequences by PCR. Three positive samples were obtained by concentration and conventional microscopy, two by immunoassay and 26 by molecular techniques. The study suggests that routine diagnostic tests based on conventional microscopy and immunoassay have lower detection rate of this parasite and that this deficiency can be compensated by means of the implementation of molecular diagnostic methods based on PCR, as a complementary strategy to support the diagnosis of this protozoan.