Blood RNA Biomarkers Identify Bacterial and Biofilm Coinfections in COVID-19 Intensive Care Patients

Purpose: Secondary opportunistic coinfections are a significant contributor to morbidity and mortality in intensive care unit (ICU) patients, but can be difficult to identify. Presently, new blood RNA biomarkers were tested in ICU patients to diagnose viral, bacterial, and biofilm coinfections. Meth...

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Bibliographic Details
Published in:Journal of intensive care medicine 2024-11, Vol.39 (11), p.1071-1082
Main Authors: Cruz, Philip Dela, Wargowsky, Richard, Gonzalez-Almada, Alberto, Sifontes, Erick Perez, Shaykhinurov, Eduard, Jaatinen, Kevin, Jepson, Tisha, Lafleur, John E., Yamane, David, Perkins, John, Pasquale, Mary, Giang, Brian, McHarg, Matthew, Falk, Zach, McCaffrey, Timothy A.
Format: Article
Language:English
Subjects:
Adult
Aged
Alkaline Phosphatase - blood
Bacterial Infections - blood
Bacterial Infections - diagnosis
Biofilms - growth & development
Biomarkers - blood
Coinfection - blood
Coinfection - microbiology
COVID-19 - blood
COVID-19 - complications
COVID-19 - diagnosis
Critical Care
Female
Humans
Intensive Care Units
Male
Middle Aged
RNA - blood
SARS-CoV-2
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Summary:Purpose: Secondary opportunistic coinfections are a significant contributor to morbidity and mortality in intensive care unit (ICU) patients, but can be difficult to identify. Presently, new blood RNA biomarkers were tested in ICU patients to diagnose viral, bacterial, and biofilm coinfections. Methods: COVID-19 ICU patients had whole blood drawn in RNA preservative and stored at −80°C. Controls and subclinical infections were also studied. Droplet digital polymerase chain reaction (ddPCR) quantified 6 RNA biomarkers of host neutrophil activation to bacterial (DEFA1), biofilm (alkaline phosphatase [ALPL], IL8RB/CXCR2), and viral infections (IFI27, RSAD2). Viral titer in blood was measured by ddPCR for SARS-CoV2 (SCV2). Results: RNA biomarkers were elevated in ICU patients relative to controls. DEFA1 and ALPL RNA were significantly higher in severe versus incidental/moderate cases. SOFA score was correlated with white blood cell count (0.42), platelet count (−0.41), creatinine (0.38), and lactate dehydrogenase (0.31). ALPL RNA (0.59) showed the best correlation with SOFA score. IFI27 (0.52) and RSAD2 (0.38) were positively correlated with SCV2 viral titer. Overall, 57.8% of COVID-19 patients had a positive RNA biomarker for bacterial or biofilm infection. Conclusions: RNA biomarkers of host neutrophil activation indicate the presence of bacterial and biofilm coinfections in most COVID-19 patients. Recognizing coinfections may help to guide the treatment of ICU patients.
ISSN:0885-0666
1525-1489
1525-1489
DOI:10.1177/08850666241251743