A comparison of host response strategies to distinguish bacterial and viral infection.

Abstract

ObjectivesCompare three host response strategies to distinguish bacterial and viral etiologies of acute respiratory illness (ARI).MethodsIn this observational cohort study, procalcitonin, a 3-protein panel (CRP, IP-10, TRAIL), and a host gene expression mRNA panel were measured in 286 subjects with ARI from four emergency departments. Multinomial logistic regression and leave-one-out cross validation were used to evaluate the protein and mRNA tests.ResultsThe mRNA panel performed better than alternative strategies to identify bacterial infection: AUC 0.93 vs. 0.83 for the protein panel and 0.84 for procalcitonin (PConclusionsA gene expression signature was the most accurate host response strategy for classifying subjects with bacterial, viral, or non-infectious ARI.