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1726 Integrating established clinical scores with a novel transcriptomic severity classifier augments early risk assessment in the ED
  1. Eva Diehl-Wiesenecker1,
  2. Noa Galtung1,
  3. Oliver Liesenfeld2,
  4. Florian Uhle2,
  5. Timothy E Sweeney2,
  6. Wolfgang Bauer1
  1. 1Department of Emergency Medicine, Campus Benjamin Franklin, Charité Universitaetsmedizin, Berlin, Germany
  2. 2Clinical Affairs, Inflammatix Inc., Redwood City, USA


Aims, Objectives and Background Reliable risk assessment in patients presenting to emergency departments (ED) with suspected infection is of utmost importance to support clinical decisions. Vital sign-based scoring systems such as NEWS2 or qSOFA enable a rapid first assessment of patient urgency at triage. However, their inherent high sensitivity might drive over-utilization of healthcare resources. Our aim was to evaluate if adding the result of a transcriptomic severity classifier can synergistically improve current score-based risk assessment in the ED.

Method and Design We performed a secondary analysis of a patient cohort (n=312) enrolled in the Charité University hospital ED (Berlin, Germany) with suspected infection and at least one vital sign alteration. The expression of 29-host mRNAs in PAXgene-stabilized whole blood was quantified using NanoString nCounter® SPRINT. The proprietary machine learning classifier IMX-SEV-3 was applied to calculate a score that falls into pre-defined interpretation bands: low/moderate/high severity. NEWS2 and qSOFA were documented on admission and combined with the classifier results to analyze the incidence of two clinical endpoints: ‘need for critical care’ (composite of need for ventilation, dialysis, and/or vasopressors) within 7d and ‘28d mortality’.

Results and Conclusion Among enrolled patients, 22 (7.1%) died and 66 (21.1%) required ICU-level care. Of patients with a high NEWS2 (≥5 points; n=184), there was a stepwise increase in mortality among the low (0%; n=0/47), medium (10.1%; n=12/119) and high (44.4% n=8/18) IMX-SEV-3 severity subgroups. A similar stratification was achieved across the low (17%), moderate (31%), and high (61%) IMX-SEV-3 subgroups for prediction of critical care. More granular risk stratification could also be confirmed when using IMX-SEV-3 in combination with high qSOFA (≥2 points; n=76): 0/10.6/50% mortality and 23.5/40.4/66% need for critical care in the low/moderate/high subgroups, respectively.

In summary, the combined use of immune-based IMX-SEV-3 results for ED patients with high clinical scores allows improved prediction of mortality and the need for critical care.

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