1213 - A TRAIL/IP-10/CRP Signature Distinguishes between Viral and Bacterial Infection in Chronic Obstructive Pulmonary Disease Patients

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Co-Author(s)

MP

Meital Paz

Dr.
MeMed
Haifa, HaZafon, Israel
Disclosure: MeMed Ltd. (Employee)
SH

Salim Halabi

Director, Emergency medicine department
Carmel medical center
Haifa, HaZafon, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Shachaf Shiber

Dr shachaf shiber
senior
Tel aviv, HaMerkaz, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AN

Ami Neuberger

Infectious disease specialist
Rambam Health Care Campus
Haifa, HaZafon, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NP

Neta Petersiel

Attending physician
Rambam Health Care Campus
Haifa, HaZafon, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MG

Mordechai Grupper

Dr
Rambam medical center, Haifa, israel
Haifa, Hefa, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DK

Dani Kirshner

Attending physician
Rambam Health Care Campus
Haifa, HaZafon, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NA

Noa Avni

Assay Development Scientist
MeMed, Haifa, Israel
Haifa, Hefa, Israel
Disclosure: MeMed (Employee)
MS

Michal Stein

Research assistant
MeMed Diagnostics
Haifa, HaZafon, Israel
Disclosure: MeMed Ltd. (Employee)
GK

Gali Kronenfeld

R&D scientist
MeMed Ltd.
Haifa, Hefa, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LS

Liran Shani

Director of Medical Affairs
MeMed Diagnostics
Haifa, HaZafon, Israel
Disclosure: MeMed Ltd. (Employee)
TG

Tanya Gottlieb

Dr.
MeMed Diagnostics
Tirat Carmel, HaZafon, Israel
Disclosure: MeMed (Employee)
YL

Ynon Lishtzinsky

Attending physician
Rabin medical center
Petah Tikva, HaMerkaz, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YM

Yasmin Maor

Head of Infectious Disease Unit
, Wolfson Medical Center
Holon, Tel Aviv, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SY

Shirly Yanai

Attending physician
Rabin medical center
Petah Tikva, HaMerkaz, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KO

Kfir Oved

Dr.
MeMed Diagnostics
Tirat Carmel, HaZafon, Israel
Disclosure: MeMed (Employee)

Presenting Author(s)

EE

Eran Eden

Dr.
MeMed Diagnostics
Tirat Carmel, HaZafon, Israel
Disclosure: MeMed (Employee)

Co-Author(s)

MD

Michael Drescher

Director, Emergency medicine department
Rabin medical center
Petah Tikva, HaMerkaz, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MP

Michal Paul

Director, Infectious Diseases Institute
Rambam Health Care Campus
Haifa, Hefa, Israel
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Challenges in determining the etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant overuse of antibiotics. A new host-response assay that integrates the levels of three proteins (TRAIL, IP-10, and CRP) was shown to exhibit high performance in distinguishing between bacterial and viral disease in two double-blind pediatric validation studies. Here we sought to evaluate its ability to differentiate bacterial from viral infection in adult COPD patients with suspicion of lower respiratory tract infection (LRTI).

Methods: The study population included 492 febrile adult patients prospectively recruited in “Observer”, an EU Horizon 2020 funded study (grant #684589). Patient etiology was determined by majority expert panel based on clinical, laboratory, multiplex PCR, radiological and follow-up data. We compared the expert panel diagnosis with the assay that gives three possible outcomes: viral, bacterial (including viral with bacterial coinfection) or equivocal.

Results: 45 out 492 adult patients prospectively recruited with suspicion of LRTI had a medical history of COPD. Of these, 20 cases were assigned as suspected viral infections and 19 as suspected bacterial infections (Figure 1). Antibiotics were prescribed to 19/19 bacterial infections and 16/20 viral infections. The assay correctly classified 19/19 bacterial infections and 12/20 viral infections, with 2 viral cases classified by the assay as bacterial and 6 receiving an equivocal outcome. These data support the assay’s potential to reduce antibiotic overuse from 16/20=80% to 8/20=40% (P=0.01).FIgure 1: Flow through of COPD patients in prospective performance validation study "Observer"

Conclusion: A new TRAIL/IP-10/CRP signature has potential to significantly reduce antibiotic overuse for patients with suspected LRTI and a history of COPD without missing bacterial infection.