Reduction of resources with mRNA host-response whole blood testing on patients presenting to the emergency department with suspected infections: a retrospective analysis of 30 cases

<b>Introduction.</b> The TriVerity™ test (Inflammatix Inc.) uses the patient's mRNA expression patterns from whole blood to provide a site-agnostic likelihood of bacterial infection and/or viral infection. The test also reports an illness severity score, an all-cause predictor of the need for critical care (mechanical ventilation, vasopressor therapy or renal replacement therapy) within 7 days of testing.<b>Hypothesis/Gap Statement.</b> Differentiating the source and assessing disease severity in patients presenting to the emergency department (ED) with signs and symptoms of sepsis remains an unmet medical need.<b>Aim.</b> The results of the TriVerity test were compared to the EPIC sepsis score, systemic inflammatory response syndrome criteria, discharge diagnoses, location of patient discharge and an assessment of potential cost savings in unnecessary resource utilization.<b>Methodology.</b> Blood was retained from 30 patients presenting to the ED with signs and symptoms suggestive of sepsis. Remnant EDTA-preserved blood from routine medical testing was transferred into PAXgene tubes, stored frozen and retrospectively tested with TriVerity.<b>Results.</b> TriVerity was correctly correlated with clinical diagnosis and outcomes in 29 of 30 patients with one false negative (low severity score for sepsis diagnosis, admitted for bladder cancer and on pre-existing antibiotic therapy). For two patients with a positive TriVerity bacterial and severity score, antibiotic treatment may have been initiated 6-9 h earlier if tested prospectively. Twelve patients were discharged home with a mean ED length of stay of 7.25 h, of which 7 (58 %) had a positive EPIC sepsis score (>5) and all had a low TriVerity severity score. If this test were performed prospectively at ED presentation, a net savings of $351 per patient is estimated in direct laboratory, radiology and ED costs alone, without consideration of potentially shorter hospital stays or changed disposition.<b>Conclusion.</b> The TriVerity test may enable early consideration of ruling in or out of bacterial and/or viral infection, provide severity assessment of adult patients presenting to the ED suspected of, and help reduce unnecessary utilization of laboratory and ED resources.