{"doi":"10.1093/cid/ciab043","title":"Validation of a Host Gene Expression Test for Bacterial/Viral Discrimination in Immunocompromised Hosts","abstract":"BACKGROUND: Host gene expression has emerged as a complementary strategy to pathogen detection tests for the discrimination of bacterial and viral infection. The impact of immunocompromise on host-response tests remains unknown. We evaluated a host-response test discriminating bacterial, viral, and noninfectious conditions in immunocompromised subjects. METHODS: An 81-gene signature was measured using real-time-polymerase chain reaction in subjects with immunocompromise (chemotherapy, solid-organ transplant, immunomodulatory agents, AIDS) with bacterial infection, viral infection, or noninfectious illness. A regularized logistic regression model trained in immunocompetent subjects was used to estimate the likelihood of each class in immunocompromised subjects. RESULTS: Accuracy in the 136-subject immunocompetent training cohort was 84.6% for bacterial versus nonbacterial discrimination and 80.8% for viral versus nonviral discrimination. Model validation in 134 immunocompromised subjects showed overall accuracy of 73.9% for bacterial infection (P = .04 relative to immunocompetent subjects) and 75.4% for viral infection (P = .30). A scheme reporting results by quartile improved test utility. The highest probability quartile ruled-in bacterial and viral infection with 91.4% and 84.0% specificity, respectively. The lowest probability quartile ruled-out infection with 90.1% and 96.4% sensitivity for bacterial and viral infection, respectively. Performance was independent of the type or number of immunocompromising conditions. CONCLUSIONS: A host gene expression test discriminated bacterial, viral, and noninfectious etiologies at a lower overall accuracy in immunocompromised patients compared with immunocompetent patients, although this difference was only significant for bacterial infection classification. With modified interpretive criteria, a host-response strategy may offer clinically useful diagnostic information for patients with immunocompromise.","journal":"Clinical Infectious Diseases","year":2021,"id":187604,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9528,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":118590,"name":"Sunil Suchindran","orcid":null,"position":1,"is_corresponding":false},{"id":331976,"name":"Ricardo Henao","orcid":"0000-0003-4980-845X","position":2,"is_corresponding":false},{"id":385243,"name":"Julie M. Steinbrink","orcid":"0000-0003-0771-3647","position":3,"is_corresponding":false},{"id":37802,"name":"Thomas W. Burke","orcid":"0000-0003-0592-5822","position":4,"is_corresponding":false},{"id":355859,"name":"Micah T. McClain","orcid":"0000-0001-8034-1136","position":5,"is_corresponding":false},{"id":6434,"name":"Geoffrey S. Ginsburg","orcid":"0000-0003-4739-9808","position":6,"is_corresponding":false},{"id":33039,"name":"Christopher W. Woods","orcid":"0000-0001-7240-2453","position":7,"is_corresponding":false},{"id":355864,"name":"Ephraim L. Tsalik","orcid":"0000-0002-6417-2042","position":8,"is_corresponding":false},{"id":747751,"name":"Rachael Mahle","orcid":null,"position":0,"is_corresponding":true}],"reference_count":39,"raw_metadata":null,"created_at":"2026-07-18T23:48:55.420619Z","pmid":"33462581","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}