{"doi":"10.1371/journal.pone.0261385","title":"A comparison of host response strategies to distinguish bacterial and viral infection","abstract":"OBJECTIVES: Compare three host response strategies to distinguish bacterial and viral etiologies of acute respiratory illness (ARI). METHODS: In this observational cohort study, procalcitonin, a 3-protein panel (CRP, IP-10, TRAIL), and a host gene expression mRNA panel were measured in 286 subjects with ARI from four emergency departments. Multinomial logistic regression and leave-one-out cross validation were used to evaluate the protein and mRNA tests. RESULTS: The mRNA panel performed better than alternative strategies to identify bacterial infection: AUC 0.93 vs. 0.83 for the protein panel and 0.84 for procalcitonin (P<0.02 for each comparison). This corresponded to a sensitivity and specificity of 92% and 83% for the mRNA panel, 81% and 73% for the protein panel, and 68% and 87% for procalcitonin, respectively. A model utilizing all three strategies was the same as mRNA alone. For the diagnosis of viral infection, the AUC was 0.93 for mRNA and 0.84 for the protein panel (p<0.05). This corresponded to a sensitivity and specificity of 89% and 82% for the mRNA panel, and 85% and 62% for the protein panel, respectively. CONCLUSIONS: A gene expression signature was the most accurate host response strategy for classifying subjects with bacterial, viral, or non-infectious ARI.","journal":"PLoS ONE","year":2021,"id":192552,"datarank":0.38474240361923057,"base_score":2.5649493574615367,"endowment":2.5649493574615367,"self_citation_contribution":0.38474240361923057,"citation_network_contribution":0.0,"self_endowment_contribution":0.38474240361923057,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9586,"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":331976,"name":"Ricardo Henao","orcid":"0000-0003-4980-845X","position":1,"is_corresponding":false},{"id":37802,"name":"Thomas W. Burke","orcid":"0000-0003-0592-5822","position":2,"is_corresponding":false},{"id":104990,"name":"Emily R. Ko","orcid":"0000-0003-0542-3750","position":3,"is_corresponding":false},{"id":355859,"name":"Micah T. McClain","orcid":"0000-0001-8034-1136","position":4,"is_corresponding":false},{"id":6434,"name":"Geoffrey S. Ginsburg","orcid":"0000-0003-4739-9808","position":5,"is_corresponding":false},{"id":33039,"name":"Christopher W. Woods","orcid":"0000-0001-7240-2453","position":6,"is_corresponding":false},{"id":355864,"name":"Ephraim L. Tsalik","orcid":"0000-0002-6417-2042","position":7,"is_corresponding":false},{"id":759691,"name":"Melissa Ross","orcid":"0000-0001-8206-1584","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:49:43.496702Z","pmid":"34905580","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":[]}