29-mRNA host response signatures for classification of bacterial infection, viral infection and disease progression in COVID-19 pneumonia: a post hoc analysis of the SAVE-MORE randomized clinical trial.

Publication date: Jun 30, 2025

Biomarkers based on host response signatures are currently under development for the critically ill. We applied a 29-mRNA classifier for the diagnosis and prognosis of suspected acute infection and sepsis (TriVerity, Inflammatix Inc. ) in patients hospitalized with COVID-19. We applied three scores from locked classifiers (IMX-BVN-4 and IMX-SEV-4) from the 29-mRNA TriVerity blood test in participants of the SAVE-MORE randomized clinical trial (ClinicalTrials. gov NCT04680949) at baseline and days 4 and 7 of treatment, to classify bacterial infection, viral infection and decompensation. Participants were adults hospitalized with confirmed COVID-19 pneumonia and plasma soluble urokinase plasminogen activator receptor (suPAR) levels of ≥ 6 ng/ml, randomized to placebo or anakinra treatment. A total of 471 patients were studied. At baseline nearly 90% had a Very Low or Low IMX-BVN-4 Bacterial Score and Moderate, High or Very High IMX-BVN-4 Viral Score. Anakinra treatment had an effect on the expression of genes indicating IMX-SEV-4 High or Very High scores after a 7 day treatment compared to baseline (12. 9% of anakinra-treated patients continued being classified as high severity vs 20. 4% of placebo-treated patients, p 0. 046). The classifiers were well tested in COVID-19 pneumonia and may become a useful tool for hospitalized patients.

Concepts Keywords
Biomarkers Anakinra
Decompensation Bacterial infection
Nct04680949 COVID-19
Pneumonia Diagnostics
Viral Gene expression
Host response
Mortality
Secondary infection
Severity
Viral infection

Semantics

Type Source Name
disease IDO host
disease MESH bacterial infection
disease MESH viral infection
disease MESH disease progression
disease MESH COVID-19
disease MESH pneumonia
disease MESH critically ill
disease IDO acute infection
disease MESH sepsis
disease IDO blood
drug DRUGBANK Anakinra
disease MESH Secondary infection

Original Article

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