The American journal of emergency medicine · 2025
IMX-SEV-3b mRNA classifier predicts ICU care and 30-day mortality in febrile neutropenic emergency department patients.
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Meguerdichian David A, Jambaulikar Guruprasad, Liesenfeld Oliver, Rasania Shailee, Joseph Joshua, Wacker James, Baugh Christopher W
Аннотация
BACKGROUND: Chemotherapy-associated febrile neutropenia (FN) is a common, life-threatening oncologic emergency. Scores to identify low-risk patients eligible for outpatient treatment, like the Multinational Association for Supportive Care in Cancer (MASCC), Clinical Index of Stable Febrile Neutropenia (CISNE), and quick Sepsis Related Organ Failure Assessment (qSOFA) scores, are infrequently used. New tools are needed to inform risk and enable appropriate management.
METHODS: We conducted a prospective cohort study of FN patients at an urban tertiary care academic ED between October 2015 and March 2018. Samples were collected for RNA extraction and host gene amplification. IMX-SEV-3b generates an illness severity score that falls into five interpretation bands ranging from Very Low to Very High. We used the IMX-SEV-3b classifier to determine 30-day ICU care and mortality risk.
RESULTS: Among 105 patients analyzed, 63 (60.0%) had sufficient mRNA concentrations. IMX-SEV-3b showed an area under the curve (AUC) of 0.98 for predicting 30-day ICU care outperforming CISNE (AUC 0.60, p = 0.033) and MASCC (AUC 0.91, p = 0.016), while performing similarly to qSOFA (AUC 0.95), p = 0.47). For 30-day mortality, IMX-SEV-3b showed an AUC of 0.84, superior to CISNE (AUC 0.55, p = 0.018), and comparable to MASCC (AUC 0.84, p = 0.975) and qSOFA (AUC 0.91, p = 0.507).
CONCLUSION: Among 63 eligible patients, IMX-SEV-3b showed high accuracy for predicting 30-day ICU care and mortality, particularly in distinguishing higher-risk patients compared to CISNE and MASCC. This approach may improve current practice, which often favors admission. Further study is needed to confirm the safety of discharging IMX-SEV-3b Low and Very Low risk patients.
METHODS: We conducted a prospective cohort study of FN patients at an urban tertiary care academic ED between October 2015 and March 2018. Samples were collected for RNA extraction and host gene amplification. IMX-SEV-3b generates an illness severity score that falls into five interpretation bands ranging from Very Low to Very High. We used the IMX-SEV-3b classifier to determine 30-day ICU care and mortality risk.
RESULTS: Among 105 patients analyzed, 63 (60.0%) had sufficient mRNA concentrations. IMX-SEV-3b showed an area under the curve (AUC) of 0.98 for predicting 30-day ICU care outperforming CISNE (AUC 0.60, p = 0.033) and MASCC (AUC 0.91, p = 0.016), while performing similarly to qSOFA (AUC 0.95), p = 0.47). For 30-day mortality, IMX-SEV-3b showed an AUC of 0.84, superior to CISNE (AUC 0.55, p = 0.018), and comparable to MASCC (AUC 0.84, p = 0.975) and qSOFA (AUC 0.91, p = 0.507).
CONCLUSION: Among 63 eligible patients, IMX-SEV-3b showed high accuracy for predicting 30-day ICU care and mortality, particularly in distinguishing higher-risk patients compared to CISNE and MASCC. This approach may improve current practice, which often favors admission. Further study is needed to confirm the safety of discharging IMX-SEV-3b Low and Very Low risk patients.