Expression of TRAIL, IP-10, and CRP in children with suspected COVID-19 and real-life impact of a computational signature on clinical decision-making: a prospective cohort study

• Published in: Infection Vol. 51; no. 5; pp. 1349 - 1356
• Main Authors: Fröhlich, Franziska, Gronwald, Benjamin, Bay, Johannes, Simon, Arne, Poryo, Martin, Geisel, Jürgen, Tegethoff, Sina A., Last, Katharina, Rissland, Jürgen, Smola, Sigrun, Becker, Sören L., Zemlin, Michael, Meyer, Sascha, Papan, Cihan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2023; Springer Nature B.V
• Subjects: Antibiotics; Bacteria; Bacterial diseases; Bacterial infections; Biomarkers; Children; Clinical decision making; Cohort analysis; COVID-19; Decision analysis; Decision making; Family Medicine; General Practice; Infectious Diseases; Internal Medicine; IP-10 protein; Medicine; Medicine & Public Health; Pediatrics; Physicians; Severe acute respiratory syndrome coronavirus 2; Viral infections; COVID-19; Emergency department; C-reactive protein; Biomarkers; IP-10 protein; Antimicrobial stewardship; TRAIL protein; Children; Clinical decision-making
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-023-01993-1

Purpose We evaluated the host-response marker score “BV” and its components TRAIL, IP-10, and CRP in SARS-CoV-2 positive children, and estimated the potential impact on clinical decision-making. Methods We prospectively analyzed levels of TRAIL, IP-10, CRP, and the BV score, in children with suspected COVID-19. Classification of infectious etiology was performed by an expert panel. We used a 5-point-questionnaire to evaluate the intention to treat with antibiotics before and after receiving test results. Results We screened 111 children, of whom 6 (5.4%) were positive for SARS-CoV-2. A total of 53 children were included for the exploratory analysis. Median age was 3.1 years (interquartile range [IQR] 1.3–4.3), and 54.7% ( n  = 29) were girls. A viral and a bacterial biomarker pattern was found in 27/53 (50.9%) and 15/53 (28.3%), respectively. BV scores differed between COVID-19, children with other viral infections, and children with bacterial infections (medians 29.5 vs. 9 vs. 66; p  = 0.0006). Similarly, median TRAIL levels were different (65.5 vs. 110 vs. 78; p  = 0.037). We found no differences in IP-10 levels (555 vs. 504 vs. 285; p  = 0.22). We found a concordance between physicians’ “unlikely intention to treat” children with a viral test result in most cases ( n  = 19/24, 79.2%). When physicians expressed a “likely intention to treat” ( n  = 15), BV test revealed 5 bacterial, viral, and equivocal scores each. Antibiotics were withheld in three cases (20%). Overall, 27/42 (64%) of pediatricians appraised the BV test positively, and considered it helpful in clinical practice. Conclusion Host-response based categorization of infectious diseases might help to overcome diagnostic uncertainty, support clinical decision-making and reduce unnecessary antibiotic treatment.