Association between clinical presentation and a host transcriptomic signature in patients with lower respiratory tract infection undergoing bronchoscopy

Résumé fourni par la source

Pulmonary infections represent an increasing percentage of the world9s total infections. The lack of a reference standard for the diagnosis of bacterial lower respiratory tract infections (LRTI) remains a challenge. We prospectively explored the association between clinical presentation, microbiology, and a blood-based 29 mRNA host-response test in patients with suspicion of LRTI. The PAX study is a prospective, single-centre observational study involving 578 cases with suspected LRTI undergoing bronchoscopy with bronchoalveolar lavage (BAL). This entails an interim analysis of 366 cases. Blood was analyzed for 29 mRNA host-response using InSep™️ (Inflammatix, California, USA). Strict definitions for very likely, possible, unlikely, and very unlikely bacterial infection were provided by the adjudicators. The patients’ average age was 62.4±15.3 years. Clinical presentation but not microbiological methods were significantly differentiated across the categories assessing probability of bacterial infection by mRNA signatures (p=<0.0001 and p=0.4862, respectively). Using conventional methods as a reference standard, the mRNA host-response score showed 36.3% sensitivity and 75.0% specificity, compared to clinical presentation that showed 71.0% sensitivity and 54.5% specificity for bacterial infection. There is an association between clinical judgement and an inflammatory host-response test for bacterial infections. Complementary aspects for the likelihood of infection may be clinical presentation, microbiology, and mRNA host-response. The evaluation of the entire cohort will allow robust inferences after completion of analyses soon.

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