Researcher Uses Diagnostic Lung Test to Identify Patients at Highest Risk of COVID-19 Complications
A University of Toronto researcher has received more than $970,000 in federal funding to examine how a new diagnostic lung test can help identify COVID-19 patients at the greatest risk of severe illness and death.
The test could enable emergency room staff to quickly distinguish between high-risk patients and those with mild illness, thereby alleviating pressure on the health care system.
“We know the big problem with the COVID-19 epidemic is that the majority of people are going to get it and most will be fine, and recover from it. We need a better way to identify those most likely to get into trouble,” says Dr. Shaf Keshavjee, a professor of thoracic surgery at U of T who is director of the Toronto Lung Transplant Program, surgeon-in-chief at University Health Network, and program medical director of surgery and critical care at UHN.
The Canadian Institutes of Health Research has provided funding for the work, as part of a national $54.2 million research funding package announced in early April.
“Once you know how severely someone will be affected, the second important thing you need to be able to do is triage patients within the emergency room, in order to prevent overwhelming of the health care system,” says Keshavjee.
The origins of the RALI-Dx – which stands for the Rapid Acute Lung Injury Diagnostic test – came from devices designed to measure the lung quality of donor lungs, for patients in need of lung transplantation. The test was developed at UHN.
Now, as a result of the funding to Keshavjee and UHN, the research will focus on how the 40-minute test can identify patients at the highest risk of lung failure due to COVID-19, so health care teams can connect those patients to the most appropriate treatment pathways.
“What kills the patient in SARS and in COVID-19 isn’t necessarily the virus itself. It’s sometimes the hosts’ response to the virus,” he says.
“The hosts that have an exaggerated inflammatory response are the ones that are going to get really sick. The ones who don’t have an exaggerated response are going to feel badly, but they can go home and self-isolate and get better.”
For the test to work, health care providers do a blood draw of patients who have come to the emergency room showing symptoms of a flu-like illness. The tube of blood then goes to a microbiology lab in the hospital with a medical device known as a sqidlite.
In the lab, the plasma is spun off and squirted onto a plate, providing health care providers with a result that shows the extent of an inflammatory injury of the lung.
Providers can then use this diagnostic information to determine which patients are in need of more urgent care and should be admitted to hospital, and which patients can be discharged to self-isolate at home, thereby stopping overloading of the health care system, says Keshavjee.
“Everyone is in a race to get a test that will diagnose the virus faster, and the presence of the virus faster. But, what we are looking at is the impact of the virus, or the implication, in terms of helping clinicians decide what might happen next with a particular patient,” he says.
It’s hoped that the use of the device will lead to more rapid triage in the emergency room of patients, says Keshavjee, and the research supported by the CIHR will examine how the use of the device works for this purpose.
The test was originally designed by Keshavjee and his team to identify and measure biomarkers in donor lungs, with the goal of providing a personalized medicine approach to organ assessment for transplant.
Keshavjee says the test – which is being further developed in partnership with the Toronto-based company SQI Diagnostics – is a reflection of the overall move towards personalized medicine.
“What we set out to do is to bring personalized medicine or rapid diagnostics to the field of donor organ management, in assessing lungs for transplant,” says Keshavjee. “We set out to develop a test to diagnose problems with donor lungs and predict which ones would have a good outcome and which ones wouldn’t.”
In the new application of the device, it’s being used to identify biomarkers that indicate early lung injuries related to the viral infection of the lungs due to COVID-19, says Keshavjee.
Keshavjee notes the RALI-Dx was created to deliver results in an accelerated way – within minutes, not hours or days, like other molecular diagnostic tests.
“We now have diagnostics in medicine that guide care for many patients in a personalized way,” he says.
Ultimately, Keshavjee would like to be able to get the results within 10 minutes. Right now, the test can deliver results within 40 minutes.
“That’s the huge potential value this device brings to the health care system, not just in diagnosing COVID-19, but in assessing the severity of any flu-like illness,” says Keshavjee. “This research can save lives and save valuable resources in the emergency room and a hospital setting, especially in a pandemic that creates such immense strains on the system.”
