HNL (Human Neutrophil Lipocalin) and a multimarker approach to the distinction between bacterial and viral infections.

Abstract

OBJECTIVES:

The distinction between bacterial and viral causes of acute infections is a major clinical challenge. In this report we investigate the diagnostic performance in this regard of nine candidate biomarkers together with HNL (Human Neutrophil Lipocalin).

METHODS:

Blood was obtained from patients with symptoms of infectious (n = 581). HNL was measured in whole blood (B-HNL) after pre-activation with the neutrophil activator fMLP or in plasma (P-HNL). Azurocidin also known as heparin-binding protein (HBP), Calprotectin, PMN-CD64, CRP (C-reactive protein), IP-10 (Interferon γ-induced Protein 10 kDa), PCT (Procalcitonin), TK1 (Thymidine kinase 1), TRAIL (TNF-related apoptosis-inducing ligand) were measured in plasma/serum. Area under the ROC (receiver operating characteristics) curve (AuROC) was used for the evaluation of the clinical performance of the biomarkers.

RESULTS:

Side-by-side comparisons of the ten biomarkers showed large difference in the AuROC with B-HNL being the superior biomarker (0.91, 95% CI 0.86-0.95) and with the other nine biomarkers varying from AuROC of 0.63-0.79. The combination of B-HNL with IP-10 and/or TRAIL increased the diagnostic performance further to AuROCs of 0.94-0.97. The AuROCs of the combination of CRP with IP-10 and/or TRAIL were significantly lower than combinations with B-HNL 0.87 (95% CI 0.83-0.91).

CONCLUSION:

The diagnostic performance of whole blood activated HNL was superior in the distinction between bacterial or viral infections. The addition of IP-10 and/or TRAIL to the diagnostic algorithm increased the performance of B-HNL further. The rapid analysis of HNL, reflecting bacterial infections, together with biomarkers reflecting viral infections may be the ideal combination of diagnostic biomarkers of acute infections.

• Authors: Per Venge, Ann-Katrin Eriksson, Sofia Holmgren, Lena Douhan-Håkansson, Christer Peterson, Shengyuan Xu, Staffan Eriksson, Daniel Garwicz, Anders Larsson, Karlis Pauksen
• Journal: Journal of immunological methods (J Immunol Methods) Vol. 474 Pg. 112627 (11 2019) ISSN: 1872-7905 [Electronic] Netherlands
• PMID: 31242445 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• CXCL10 protein, human
• Chemokine CXCL10
• Lipocalins
• TNF-Related Apoptosis-Inducing Ligand
• TNFSF10 protein, human

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bacterial Infections (blood, diagnosis, microbiology)
• Biomarkers (blood)
• Blood Chemical Analysis
• Chemokine CXCL10 (blood)
• Diagnosis, Differential
• Female
• Humans
• Lipocalins (blood)
• Male
• Middle Aged
• Neutrophils (metabolism)
• Predictive Value of Tests
• Reproducibility of Results
• TNF-Related Apoptosis-Inducing Ligand (blood)
• Virus Diseases (blood, diagnosis, virology)
• Young Adult