{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:53:47Z","timestamp":1789401227270,"version":"build-2803163510"},"reference-count":29,"publisher":"European Respiratory Society (ERS)","issue":"6","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["440205"],"award-info":[{"award-number":["440205"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"SQI Diagnostics"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2022,7,25]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients who present to an emergency department (ED) with respiratory symptoms are often conservatively triaged in favour of hospitalisation. We sought to determine if an inflammatory biomarker panel that identifies the host response better predicts hospitalisation in order to improve the precision of clinical decision making in the ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From April 2020 to March 2021, plasma samples of 641 patients with symptoms of respiratory illness were collected from EDs in an international multicentre study: Canada (n=310), Italy (n=131) and Brazil (n=200). Patients were followed prospectively for 28\u2005days. Subgroup analysis was conducted on confirmed coronavirus disease 2019 (COVID-19) patients (n=245). An inflammatory profile was determined using a rapid, 50-min, biomarker panel (RALI-Dx (Rapid Acute Lung Injury Diagnostic)), which measures interleukin (IL)-6, IL-8, IL-10, soluble tumour necrosis factor receptor 1 (sTNFR1) and soluble triggering receptor expressed on myeloid cells 1 (sTREM1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>RALI-Dx biomarkers were significantly elevated in patients who required hospitalisation across all three sites. A machine learning algorithm that was applied to predict hospitalisation using RALI-Dx biomarkers had a mean\u00b1<jats:sc>sd<\/jats:sc>area under the receiver operating characteristic curve of 76\u00b16% (Canada), 84\u00b14% (Italy) and 86\u00b13% (Brazil). Model performance was 82\u00b13% for COVID-19 patients and 87\u00b17% for patients with a confirmed pneumonia diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The rapid diagnostic biomarker panel accurately identified the need for inpatient care in patients presenting with respiratory symptoms, including COVID-19. The RALI-Dx test is broadly and easily applicable across many jurisdictions, and represents an important diagnostic adjunct to advance ED decision-making protocols.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.00459-2022","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T00:05:42Z","timestamp":1663200342000},"page":"2200459","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["A biomarker assay to risk-stratify patients with symptoms of respiratory tract infection"],"prefix":"10.1183","volume":"60","author":[{"given":"Shahid","family":"Husain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Sage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"del Sorbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Cypel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tereza","family":"Martinu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7243-556X","authenticated-orcid":false,"given":"Stephen C.","family":"Juvet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mariscal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie T.","family":"Chao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7074-437X","authenticated-orcid":false,"given":"Alaa A.","family":"Shamandy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Hossein","family":"Mousavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome","family":"Valero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Landes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharaniyaa","family":"Balachandran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberley","family":"Hudson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Ngai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marialessia","family":"Capuano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gelardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Lupia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Marinowic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederico O.","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine R.R.","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leticya S.M.","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florencia M.","family":"Barbe-Tuana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus H.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Kain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Mazzulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Sabbah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4547-8094","authenticated-orcid":false,"given":"Shaf","family":"Keshavjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"2024102103031065000_60.6.2200459.1","unstructured":"Canadian Institute for Health Information . Data Quality Documentation: National Ambulatory Care Reporting System \u2013 Current-Year Information 2018\u20132019. 2019. www.cihi.ca\/sites\/default\/files\/document\/current-year-information-nacrs-2018-2019-en-web.pdf Date last accessed: 1 August 2022."},{"key":"2024102103031065000_60.6.2200459.2","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.5.377"},{"key":"2024102103031065000_60.6.2200459.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"2024102103031065000_60.6.2200459.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.05.008"},{"key":"2024102103031065000_60.6.2200459.5","doi-asserted-by":"publisher","DOI":"10.1038\/S41591-020-1051-9"},{"key":"2024102103031065000_60.6.2200459.6","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202005-15830C"},{"key":"2024102103031065000_60.6.2200459.7","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1080\/22221751.2020.1770129","article-title":"Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors","volume":"9","author":"Han","year":"2020","journal-title":"Emerg Microbes Infect"},{"key":"2024102103031065000_60.6.2200459.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1038-6"},{"key":"2024102103031065000_60.6.2200459.9","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jaci.2020.10.001","article-title":"COVID-19 risk stratification algorithms based on sTREM-1 and IL-6 in emergency department","volume":"147","author":"Van Singer","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"2024102103031065000_60.6.2200459.10","doi-asserted-by":"crossref","first-page":"592727","DOI":"10.3389\/fimmu.2021.592727","article-title":"Increased serum levels of soluble TNF-\u03b1 receptor is associated with ICU mortality in COVID-19 patients","volume":"12","author":"Mortaz","year":"2021","journal-title":"Front Immunol"},{"key":"2024102103031065000_60.6.2200459.11","doi-asserted-by":"crossref","first-page":"BSR20210940","DOI":"10.1042\/BSR20210940","article-title":"Increased sTREM-1 plasma concentrations are associated with poor clinical outcomes in patients with COVID-19","volume":"41","author":"de Nooijer","year":"2021","journal-title":"Biosci Rep"},{"key":"2024102103031065000_60.6.2200459.12","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.healun.2021.03.002","article-title":"Prediction of donor related lung injury in clinical lung transplantation using a validated ex vivo lung perfusion inflammation score","volume":"40","author":"Sage","year":"2021","journal-title":"J Heart Lung Transplant"},{"key":"2024102103031065000_60.6.2200459.13","unstructured":"Chen T , Guestrin C . XGBoost: a scalable tree boosting system. 2016. https:\/\/dl.acm.org\/doi\/epdf\/10.1145\/2939672.2939785 Date last accessed: 1 August 2022."},{"key":"2024102103031065000_60.6.2200459.14","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202105-1302oc"},{"key":"2024102103031065000_60.6.2200459.15","first-page":"577","article-title":"Profiling inflammation and tissue injury markers in perfusate and bronchoalveolar lavage fluid during human ex vivo lung perfusion","volume":"51","author":"Andreasson","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024102103031065000_60.6.2200459.16","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000974"},{"key":"2024102103031065000_60.6.2200459.17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1297"},{"key":"2024102103031065000_60.6.2200459.18","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1080\/07853890.2020.1868564","article-title":"Clinical and inflammatory features based machine learning model for fatal risk prediction of hospitalized COVID-19 patients: results from a retrospective cohort study","volume":"53","author":"Guan","year":"2021","journal-title":"Ann Med"},{"key":"2024102103031065000_60.6.2200459.19","doi-asserted-by":"crossref","unstructured":"Chowdhury MEH , Rahman T , Khandakar A , et al. An early warning tool for predicting mortality risk of COVID-19 patients using machine learning. Cognit Comput 2021; in press [https:\/\/doi.org\/10.1007\/s12559-020-09812-7]. doi:10.1007\/s12559-020-09812-7","DOI":"10.1007\/s12559-020-09812-7"},{"key":"2024102103031065000_60.6.2200459.20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249285"},{"key":"2024102103031065000_60.6.2200459.21","doi-asserted-by":"crossref","first-page":"e2116901","DOI":"10.1001\/jamanetworkopen.2021.16901","article-title":"Clinical characterization and prediction of clinical severity of SARS-CoV-2 infection among US adults using data from the US National COVID Cohort Collaborative","volume":"4","author":"Bennett","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2024102103031065000_60.6.2200459.22","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2009.133280"},{"key":"2024102103031065000_60.6.2200459.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.01.003"},{"key":"2024102103031065000_60.6.2200459.24","doi-asserted-by":"publisher","DOI":"10.1186\/cc11447"},{"key":"2024102103031065000_60.6.2200459.25","doi-asserted-by":"crossref","unstructured":"Tyagi A , Tyagi S , Agrawal A , et al. Early warning scores at time of ICU admission to predict mortality in critically ill COVID-19 patients. Disaster Med Public Health Prep 2021; in press [https:\/\/doi.org\/10.1017\/dmp.2021.208]. doi:10.1017\/dmp.2021.208","DOI":"10.1017\/dmp.2021.208"},{"key":"2024102103031065000_60.6.2200459.26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejim.2020.08.006","article-title":"Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression","volume":"81","author":"Frantz","year":"2020","journal-title":"Eur J Intern Med"},{"key":"2024102103031065000_60.6.2200459.27","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02113-2020"},{"key":"2024102103031065000_60.6.2200459.28","doi-asserted-by":"publisher","DOI":"10.1086\/644741"},{"key":"2024102103031065000_60.6.2200459.29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-10-12"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.00459-2022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:09:01Z","timestamp":1740380941000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.00459-2022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,14]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,12,15]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1183\/13993003.00459-2022"],"URL":"https:\/\/doi.org\/10.1183\/13993003.00459-2022","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,14]]}}}