Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation
Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation
Objectives: FebriDx is a CE-marked, FDA-approved point-of-care test that detects the antiviral host response protein Myxovirus Resistance Protein A (MxA), in addition to C-reactive protein, using finger-prick blood. FebriDx MxA detection had a high negative predictive value for COVID-19 in symptomatic adults presenting to hospital in the first waves of the pandemic and was used subsequently as a ‘rule out’ triage tool in Emergency departments. The diagnostic accuracy of FebriDx MxA in the current context of co-circulation of influenza, SARS-CoV-2, and Respiratory Syncytial Virus (RSV), and in the era of COVID-19 vaccination, is unknown.
Methods: we retrospectively evaluated the diagnostic performance of FebriDx MxA in adults with acute respiratory symptoms presenting to the Emergency Department (ED) of a large UK teaching hospital using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the reference standard (Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV).
Results: between March 9th 2022 and March 8th 2023, 5426 patients had both FebriDx and RT-PCR testing with valid results. 999 (18.4%) of patients had influenza detected, 520 (9.6%) SARS-CoV-2, and 190 (3.5%) RSV. Negative Predictive Value (NPV) of MxA detection by FebriDx was 97.5% (96.9-98.0) for influenza, 97.1% (96.4-97.7) for SARS-CoV-2, 98.1% (97.5-98.6) for RSV, and 92.8% (91.8-93.7) for all viruses combined.
Conclusions: in symptomatic adults FebriDx MxA had a high NPV for influenza and RSV, and retained a high NPV for SARS-CoV-2, in the context of virus co-circulation and widespread COVID-19 vaccination. FebriDx continues to be a useful ‘rule out’ triage tool in the ED and could potentially be scaled to provide a national triage solution for future viral pandemics.
FebriDx, Host response, Influenza, Point-of-care test, RSV, SARS-CoV-2
41-47
Brendish, Nathan J.
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Davis, Cai
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Chapman, Mary
ca9be874-fb36-48f7-bd62-b6ddeca35d4e
Borca, Florina
118f85ef-3a02-47f5-9e2a-a7128f72bd1e
Waddington, Daniel
1d8a8b02-7faa-45f0-88f7-9e35096489d5
Hill, Christopher
def6a386-4862-415a-92b8-5d33754f131e
White, Nicola
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Clark, Tristan W.
712ec18e-613c-45df-a013-c8a22834e14f
January 2024
Brendish, Nathan J.
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Davis, Cai
a4aa4473-7285-41d5-8807-11717fdddb05
Chapman, Mary
ca9be874-fb36-48f7-bd62-b6ddeca35d4e
Borca, Florina
118f85ef-3a02-47f5-9e2a-a7128f72bd1e
Waddington, Daniel
1d8a8b02-7faa-45f0-88f7-9e35096489d5
Hill, Christopher
def6a386-4862-415a-92b8-5d33754f131e
White, Nicola
090cf7f2-2d7c-4944-b4b6-43a6779695bc
Clark, Tristan W.
712ec18e-613c-45df-a013-c8a22834e14f
Brendish, Nathan J., Davis, Cai, Chapman, Mary, Borca, Florina, Waddington, Daniel, Hill, Christopher, White, Nicola and Clark, Tristan W.
(2024)
Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation.
Journal of Infection, 88 (1), .
(doi:10.1016/j.jinf.2023.11.003).
Abstract
Objectives: FebriDx is a CE-marked, FDA-approved point-of-care test that detects the antiviral host response protein Myxovirus Resistance Protein A (MxA), in addition to C-reactive protein, using finger-prick blood. FebriDx MxA detection had a high negative predictive value for COVID-19 in symptomatic adults presenting to hospital in the first waves of the pandemic and was used subsequently as a ‘rule out’ triage tool in Emergency departments. The diagnostic accuracy of FebriDx MxA in the current context of co-circulation of influenza, SARS-CoV-2, and Respiratory Syncytial Virus (RSV), and in the era of COVID-19 vaccination, is unknown.
Methods: we retrospectively evaluated the diagnostic performance of FebriDx MxA in adults with acute respiratory symptoms presenting to the Emergency Department (ED) of a large UK teaching hospital using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the reference standard (Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV).
Results: between March 9th 2022 and March 8th 2023, 5426 patients had both FebriDx and RT-PCR testing with valid results. 999 (18.4%) of patients had influenza detected, 520 (9.6%) SARS-CoV-2, and 190 (3.5%) RSV. Negative Predictive Value (NPV) of MxA detection by FebriDx was 97.5% (96.9-98.0) for influenza, 97.1% (96.4-97.7) for SARS-CoV-2, 98.1% (97.5-98.6) for RSV, and 92.8% (91.8-93.7) for all viruses combined.
Conclusions: in symptomatic adults FebriDx MxA had a high NPV for influenza and RSV, and retained a high NPV for SARS-CoV-2, in the context of virus co-circulation and widespread COVID-19 vaccination. FebriDx continues to be a useful ‘rule out’ triage tool in the ED and could potentially be scaled to provide a national triage solution for future viral pandemics.
Text
FebriDx ED paper R1 TWC NJB clean
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Accepted/In Press date: 10 November 2023
e-pub ahead of print date: 15 November 2023
Published date: January 2024
Additional Information:
Funding Information:
We acknowledge the contribution of all the patients and clinical staff using the FebriDx in the Emergency Department and also the point-of-care RT-PCR operators at University Hospital Southampton NHS Foundation Trust. NJB is supported by the NIHR Clinical Lecturer scheme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care.
Publisher Copyright:
© 2023 The Author(s)
Keywords:
FebriDx, Host response, Influenza, Point-of-care test, RSV, SARS-CoV-2
Identifiers
Local EPrints ID: 484570
URI: http://eprints.soton.ac.uk/id/eprint/484570
ISSN: 0163-4453
PURE UUID: c9746722-39f4-43e3-8951-a3c8640e2c7e
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Date deposited: 16 Nov 2023 18:06
Last modified: 27 Apr 2024 02:10
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Contributors
Author:
Cai Davis
Author:
Mary Chapman
Author:
Florina Borca
Author:
Daniel Waddington
Author:
Christopher Hill
Author:
Nicola White
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