1. Validation of SeptiCyte RAPID to discriminate sepsis from non-infectious systemic inflammation
- Author
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Robert Balk, Annette M. Esper, Greg S. Martin, Russell R. Miller, Bert K. Lopansri, John P. Burke, Mitchell Levy, Steven Opal, Richard E. Rothman, Franco R. D'Alessio, Venkataramana K. Sidhaye, Neil R. Aggarwal, Jared A. Greenberg, Mark Yoder, Gourang Patel, Emily Gilbert, Jorge P. Parada, Majid Afshar, Jordan A. Kempker, Tom van der Poll, Marcus J. Schultz, Brendon P. Scicluna, Peter M. C. Klein Klouwenberg, Janice Liebler, Emily Blodget, Santhi Kumar, Krupa Navalkar, Thomas D Yager, Dayle Sampson, James T. Kirk, Silvia Cermelli, Roy F. Davis, and Richard B. Brandon
- Abstract
Background: SeptiCyte RAPID is a molecular test for distinguishing sepsis from non-infectious systemic inflammation. The objective of this study was the clinical validation of SeptiCyte RAPID, based on testing retrospective (banked) and prospectively collected patient samples. Methods: The cartridge-based SeptiCyte RAPID assay accepts a PAXgene blood RNA sample and provides sample-to-answer processing in about 1 hour. The test output (SeptiScore, range 0-15) falls into four interpretation bands, with higher scores indicating higher probabilities of sepsis. Retrospective (banked) and prospective samples from adult patients in ICU either having systemic inflammatory response syndrome (SIRS), or suspected of sepsis under either the Sepsis-2 or Sepsis-3 definition were tested, and results were compared to a gold standard of clinical evaluation by a blinded, three-physician external panel. A multivariable analysis was performed, in which SeptiScore was combined with other clinical variables. Results: With adjudication under the Sepsis-2 definition, SeptiCyte RAPID performance for the complete cohort (356 retrospective + 63 prospective patients) had Area Under the ROC Curve (AUC) ranging from 0.82-0.85, negative predictive value 0.91 (sensitivity 0.94) for SeptiScores between 0.1 and 5.0 (Band 1, lowest risk of sepsis), and positive predictive value 0.81 (specificity 0.90) for SeptiScores between 7.4 and 15 (Band 4, highest risk of sepsis). Performance estimates for the prospective cohort ranged from AUC 0.86-0.95. For physician-adjudicated sepsis cases that were blood culture (+) or blood, urine culture (+)(+), 43/48 (90%) of SeptiCyte scores fell in bands 3 or 4. In multivariable analysis with up to 14 additional clinical variables, SeptiScore was the most important variable for sepsis diagnosis. Comparable results were obtained when the data were reanalyzed under the Sepsis-3 definition. Conclusions: This study validates SeptiCyte RAPID for differentiating patients with sepsis vs. SIRS, on the first day of ICU admission. Trial Registration:NCT01905033(MARS),NCT02127502(VENUS),NCT05469048(NEPTUNE, retrospectively registered) at clinicaltrials.gov. Keywords: sepsis, diagnosis, host response, SIRS, sepsis scoring systems
- Published
- 2022
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