The main concern of clinicians when addressing sick patients is to promptly identify -i.e., “not miss”- those at higher risk of severe disease, so as to prioritize their care and better target therapeutic interventions. Unfortunately, risk-stratification practices for infections remain suboptimal and prone to misclassification, leading to adverse outcomes and misallocation of resources, particularly in children (and even more so among newborns) from Sub-Saharan Africa (SSA). We recently developed “B-Triage”, a point-of-care rapid triaging test, designed for the quantitative assessment of sTREM-1, a biomarker of sepsis, and a highly performing prognostic marker, irrespective of underlying disease. Levels of sTREM-1 stand out as a quantitative and independent predictor of severity and death in all-cause infections, being superior to other markers and clinical scores, showing promise also for risk-stratification of non-communicable diseases. We propose to specifically validate B-Triage for risk-stratification of all cause sickness in the newborn, the age group concentrating ~50% of all child mortality. ACROBAT-newborns aims to continue and accelerate the valorisation of our device, with clinical studies in Mozambique, Ethiopia, Uganda and Gabon; the industrialization of its prototype; and a go-to market strategy for SSA. The project includes strong components of health economics and impact assessment, as well as socio-behavioural sciences (usability, acceptability, and feasibility studies), with the overarching aim of generating the necessary evidence to support B-Triage’s introduction to the African market. The proactive use of our device for risk-stratification of the sick newborn at first clinical presentation, will determine, objectively and with high precision, those at risk of severe outcome and death, resulting in improved outcomes and survival, and an optimized use of healthcare resources, including antibiotics and high value therapeutics.

Fever is the leading reason to seek healthcare globally, with over 1 billion cases of febrile illness occurring in children annually. The vast majority of infections are uncomplicated and self-limited and can be treated conservatively. A few (<1%) are life-threatening but are often challenging to identify early in the course of illness. Our project challenges the current status quo and inefficiencies of triaging practices. We propose to develop and validate a rapid triaging tool to determine, objectively, quantitatively and with high precision those patients at risk of dying, so as to prioritize their care. The breakthrough solution lies in the ENDOTHELIUM, a newly recognized in vivo biosensor, which plays a critical role in our defense against pathogens. Endothelial cell activation and subsequent loss of integrity is a common pathway of injury in several life-threatening infections, including sepsis, malaria, or even COVID-19. Measuring specific mediators of this pathway (sTREM-1, Ang2, etc.) at first clinical presentation can reliably identify individuals at risk of dying, irrespective of the disease causing the fever, and more robustly than previously known predictors such as clinical algorithms or "classic" biomarkers. Importantly, these pathways are also "druggable", thus allowing the testing or re-purposing of specific interventions to improve outcome. We will design and produce a RTT (glucometer-like) that quantitatively measures the two markers with best predictive performance (sTREM-1 and Ang2). We will then incorporate it into 2 clinical trials (to be done in Mozambique, Gabon and Ethiopia) to 1) verify the improved performance of the proposed PoC RTT in risk-stratifying and predicting mortality among paediatric patients when compared to standard of care, and 2) test whether a specific intervention (nutritional supplementation of L-Citrulline), guided by biomarker results, improves (vs. placebo) long-term outcomes and survival after hospital discharge.