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

Philip Dela Cruz, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Richard Wargowsky, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
Alberto Gonzalez-Almada, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Erick Perez Sifontes, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Eduard Shaykhinurov, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Kevin Jaatinen, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
Tisha Jepson, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
John E. Lafleur, Department of Emergency Medicine, The George Washington University Medical Center, Washington, DC, USA.
David Yamane, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
John Perkins, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
Mary Pasquale, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
Brian Giang, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Matthew McHarg, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, Washington, DC, USA.
Zach Falk, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.
Timothy A. McCaffrey, Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, Washington, DC, USA.

Document Type

Journal Article

Publication Date

5-6-2024

Journal

Journal of intensive care medicine

DOI

10.1177/08850666241251743

Keywords

COVID-19; RNA biomarkers; SARS-CoV2; biofilm; coinfections; host immune response; inflammation

Abstract

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. 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). 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. 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.

Department

Medicine

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