1
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Li J, Zhou M, Feng JQ, Hong SM, Yang SY, Zhi LX, Lin WY, Zhu C, Yu YT, Lu LJ. Bulk RNA Sequencing With Integrated Single-Cell RNA Sequencing Identifies BCL2A1 as a Potential Diagnostic and Prognostic Biomarker for Sepsis. Front Public Health 2022; 10:937303. [PMID: 35832273 PMCID: PMC9272057 DOI: 10.3389/fpubh.2022.937303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023] Open
Abstract
Background Sepsis is one of the leading causes of morbidity and mortality worldwide in the intensive care unit (ICU). The prognosis of the disease strongly depends on rapid diagnosis and appropriate treatment. Thus, some new and accurate sepsis-related biomarkers are pressing needed and their efficiency should be carefully demonstrated. Methods Differential expression analysis and weighted gene co-expression network analysis (WGCNA) were applied to detect sepsis and monocyte/macrophage-related genes. Least absolute shrinkage and selection operator (LASSO) and random forest regression analyses were used in combination to screen out prognostic genes. Single-cell RNA sequence profiling was utilized to further verify the expression of these genes on a single cell level. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were also applied to verify the diagnostic value of the target biomarkers. Results The intersections of the genes detected by differential expression and WGCNA analyses identified 141 overlapping candidate genes that were closely related to sepsis and macrophages. The LASSO and random forest regression analyses further screened out 17 prognostic genes. Single-cell RNA sequencing analysis detected that FCGR1A and BCL2A1 might be potential biomarkers for sepsis diagnosis and the diagnostic efficacy of BCL2A1 was further validated by ROC curve and DCA. Conclusions It was revealed that BCL2A1 had good diagnostic and prognostic value for sepsis, and that it can be applied as a potential and novel biomarker for the management of the disease.
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Affiliation(s)
- Jun Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-Qi Feng
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Soon-Min Hong
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shao-Ying Yang
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lang-Xian Zhi
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wan-Yi Lin
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cheng Zhu
- Department of Disease Prevention and Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue-Tian Yu
- Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang-Jing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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2
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Udovicic I, Stanojevic I, Djordjevic D, Zeba S, Rondovic G, Abazovic T, Lazic S, Vojvodic D, To K, Abazovic D, Khan W, Surbatovic M. Immunomonitoring of Monocyte and Neutrophil Function in Critically Ill Patients: From Sepsis and/or Trauma to COVID-19. J Clin Med 2021; 10:jcm10245815. [PMID: 34945111 PMCID: PMC8706110 DOI: 10.3390/jcm10245815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
Immune cells and mediators play a crucial role in the critical care setting but are understudied. This review explores the concept of sepsis and/or injury-induced immunosuppression and immuno-inflammatory response in COVID-19 and reiterates the need for more accurate functional immunomonitoring of monocyte and neutrophil function in these critically ill patients. in addition, the feasibility of circulating and cell-surface immune biomarkers as predictors of infection and/or outcome in critically ill patients is explored. It is clear that, for critically ill, one size does not fit all and that immune phenotyping of critically ill patients may allow the development of a more personalized approach with tailored immunotherapy for the specific patient. In addition, at this point in time, caution is advised regarding the quality of evidence of some COVID-19 studies in the literature.
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Affiliation(s)
- Ivo Udovicic
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
| | - Ivan Stanojevic
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
- Institute for Medical Research, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
| | - Dragan Djordjevic
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
| | - Snjezana Zeba
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
| | - Goran Rondovic
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
| | - Tanja Abazovic
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
| | - Srdjan Lazic
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
- Institute of Epidemiology, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
| | - Danilo Vojvodic
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
- Institute for Medical Research, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
| | - Kendrick To
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK; (K.T.); (W.K.)
| | - Dzihan Abazovic
- Emergency Medical Centar of Montenegro, Vaka Djurovica bb, 81000 Podgorica, Montenegro;
| | - Wasim Khan
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK; (K.T.); (W.K.)
| | - Maja Surbatovic
- Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia; (I.U.); (D.D.); (S.Z.); (G.R.); (T.A.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia; (I.S.); (S.L.); (D.V.)
- Correspondence: ; Tel.: +381-11-2665-125
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3
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Meghraoui-Kheddar A, Chousterman BG, Guillou N, Barone SM, Granjeaud S, Vallet H, Corneau A, Guessous K, de Roquetaillade C, Boissonnas A, Irish JM, Combadière C. Two New Neutrophil Subsets Define a Discriminating Sepsis Signature. Am J Respir Crit Care Med 2021; 205:46-59. [PMID: 34731593 DOI: 10.1164/rccm.202104-1027oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sepsis is the leading cause of death in adult intensive care units. At present, sepsis diagnosis relies on non-specific clinical features. It could transform clinical care to have immune cell biomarkers that could predict sepsis diagnosis and guide treatment. For decades, neutrophil phenotypes have been studied in sepsis, but a diagnostic cell subset has yet to be identified. OBJECTIVES To identify an early specific immune signature of sepsis severity that does not overlap with other inflammatory biomarkers, and that distinguishes patients with sepsis from those with non- infectious inflammatory syndrome. METHODS Mass cytometry combined with computational high-dimensional data analysis were used to measure 42 markers on whole blood immune cells from sepsis patients and controls, and automatically and comprehensively characterize circulating immune cells, which enables identification of novel, disease-specific cellular signatures. MEASUREMENTS AND MAIN RESULTS Unsupervised analysis of high-dimensional mass cytometry data characterized previously unappreciated heterogeneity within the CD64+ immature neutrophils and revealed two new subsets distinguished by CD123 and PD-L1 expression. These immature neutrophils exhibited diminished activation and phagocytosis functions. The proportion of CD123-expressing neutrophils correlated with clinical severity. CONCLUSIONS This study showed that these two new neutrophil subsets were specific to sepsis and detectable by routine flow cytometry using seven markers. The demonstration here that a simple blood test distinguishes sepsis from other inflammatory conditions represents a key biological milestone that can be immediately translated into improvements in patient care.
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Affiliation(s)
- Aïda Meghraoui-Kheddar
- Universite de Reims Champagne-Ardenne UFR Pharmacie, 173613, EA4683, Laboratoire d'Immunologie, Reims, France
| | | | | | - Sierra M Barone
- Vanderbilt University, 5718, Nashville, Tennessee, United States
| | | | | | | | | | | | | | - Jonathan M Irish
- Vanderbilt University Medical Center, 12328, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, 12328, Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, United States.,Vanderbilt University, 5718, Department of Cell and Developmental Biology\unskip, Vanderbilt University, Nashville, Tennessee, United States
| | - Christophe Combadière
- Sorbonne Université, 27063, UPMC Univ Paris 06, Inserm, UMRS1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France;
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4
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Hung SK, Lan HM, Han ST, Wu CC, Chen KF. Current Evidence and Limitation of Biomarkers for Detecting Sepsis and Systemic Infection. Biomedicines 2020; 8:biomedicines8110494. [PMID: 33198109 PMCID: PMC7697922 DOI: 10.3390/biomedicines8110494] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
Sepsis was recently redefined as a life-threatening disease involving organ dysfunction caused by a dysregulated host response to infection. Biomarkers play an important role in early detection, diagnosis, and prognostication. We reviewed six promising biomarkers for detecting sepsis and systemic infection, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), CD64, presepsin, and sTREM-1. Among the recent studies, we found the following risks of bias: only a few studies adopted the random or consecutive sampling strategy; extensive case-control analysis, which worsened the over-estimated performance; most of the studies used post hoc cutoff values; and heterogeneity with respect to the inclusion criteria, small sample sizes, and different quantitative synthesis methods applied in meta-analyses. We recommend that CD64 and presepsin should be considered as the most promising biomarkers for diagnosing sepsis. Future studies should enroll a larger sample size with a cohort rather than a case-control study design. A random or consecutive study design with a pre-specified laboratory threshold, consistent sampling timing, and an updated definition of sepsis will also increase the reliability of the studies. Further investigations of appropriate specimens, testing assays, and cutoff levels for specific biomarkers are also warranted.
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Affiliation(s)
- Shang-Kai Hung
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (S.-K.H.); (S.-T.H.)
| | - Hao-Min Lan
- Department of Education, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Shih-Tsung Han
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (S.-K.H.); (S.-T.H.)
| | - Chin-Chieh Wu
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Kuan-Fu Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Correspondence:
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5
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Shao SL, Cong HY, Wang MY, Liu P. The diagnostic roles of neutrophil in bloodstream infections. Immunobiology 2019; 225:151858. [PMID: 31836303 DOI: 10.1016/j.imbio.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/15/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022]
Abstract
Bloodstream infections remain a leading cause of death worldwide, despite advances in critical care and understanding of the pathophysiology and treatment strategies. No specific biomarkers or therapy are available for these conditions. Neutrophils play a critical role in controlling infection and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated diagnostic biomarkers involved neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically predict the outcome of sepsis.
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Affiliation(s)
- Shu-Li Shao
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Hai-Yan Cong
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Ming-Yi Wang
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
| | - Peng Liu
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
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6
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Thiriet C, Mahjoub K, Courte G, Labroca P, Cravoisy A, Lemarie J, Conrad M, Nace L, Bollaert PE, Gibot S. Automated measurement of neutrophil CD64 expression for diagnosing sepsis in critically ill patients. Minerva Anestesiol 2019; 85:943-950. [PMID: 30871305 DOI: 10.23736/s0375-9393.19.13420-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although early identification of sepsis improves outcome, prompt and correct diagnostic remains often challenging. The expression of the high affinity immunoglobulin-Fc fragment receptor I CD64 on neutrophils is upregulated during acute inflammation. We here aimed at determining the usefulness of its rapid measurement in diagnosing sepsis. METHODS Seventy-two consecutive patients were enrolled upon admission to Intensive Care Unit within a two-month period. Sequential determination of serum C-reactive protein (CRP) and procalcitonin (PCT) concentrations was obtained. The neutrophil CD64 index was measured using Accellix-CD64® device, an in vitro diagnosis system allowing for an automatic and standardized measure. RESULTS Serum concentrations of CRP and PCT as well as the neutrophil CD64 index were higher in septic patients compared to all others (P<0.05 for the three markers). Only CD64 index was an independent predictor of sepsis, though with modest sensitivity and specificity (78% and 70%, respectively). Repeat determination of CD64 index at day 2 correctly classified 85% of patients. CONCLUSIONS This prospective study demonstrates the moderate performance of the neutrophil CD64 index, assessed through the Accellix-CD64® device, in diagnosing sepsis in the critically ill patient. However, repeat measurements improve its accuracy and may help to predict ICU-acquired infections.
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Affiliation(s)
- Claire Thiriet
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Khaoula Mahjoub
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Guilhem Courte
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Pierre Labroca
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Aurélie Cravoisy
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jérémie Lemarie
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Marie Conrad
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Lionel Nace
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Pierre-Edouard Bollaert
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Sébastien Gibot
- Service of Reanimation, Central Hospital, Nancy, France - .,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
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7
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Yeh CF, Wu CC, Liu SH, Chen KF. Comparison of the accuracy of neutrophil CD64, procalcitonin, and C-reactive protein for sepsis identification: a systematic review and meta-analysis. Ann Intensive Care 2019; 9:5. [PMID: 30623257 PMCID: PMC6325056 DOI: 10.1186/s13613-018-0479-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022] Open
Abstract
Background Neutrophil CD64 is widely described as an accurate biomarker for the diagnosis of infection in patients with septic syndrome. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of neutrophil CD64, comparing it with C-reactive protein (CRP) and procalcitonin (PCT) for the diagnosis of infection in adult patients with septic syndrome, based on sepsis-2 criteria. We searched the PubMed and Embase databases and Google Scholar. Original studies reporting the performance of neutrophil CD64 for sepsis diagnosis in adult patients were retained. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and hierarchical summary receiver operating characteristic (SROC) curve were calculated. Results We included 14 studies (2471 patients) from 2006 to 2017 in the meta-analysis. The pooled sensitivity and specificity of neutrophil CD64 for diagnosing infection in adult patients with septic syndrome were 0.87 (95% CI 0.80–0.92) and 0.89 (95% CI 0.82–0.93), respectively. The area under the SROC curve and the DOR were 0.94 (95% CI 0.92–0.96) and 53 (95% CI 22–128), respectively. There was significant heterogeneity between the studies included. Subgroup analyses showed that this heterogeneity was due to differences in sample size and the proportions of patients with sepsis included in the studies. Six studies (927 patients) compared neutrophil CD64 and CRP determinations, and six studies (744 patients) compared neutrophil CD64 and PCT determinations. The area under the SROC curve was larger for neutrophil CD64 than for CRP (0.89 [95% CI 0.87–0.92] vs. 0.84 [95% CI 0.80–0.88], P < 0.05) or PCT (0.89 [95% CI 0.84–0.95] vs. 0.84 [95% CI 0.79–0.89], P < 0.05). Conclusions In adult patients with septic syndrome, neutrophil CD64 levels are an excellent biomarker with moderate accuracy outperforming both CRP and PCT determinations. Electronic supplementary material The online version of this article (10.1186/s13613-018-0479-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun-Fu Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chieh Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Su-Hsun Liu
- Health Management Center, Far Eastern Memorial Hospital, New Taipei, Taiwan.,International Health Program, National Yang Ming University, Taipei, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. .,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, 5 Fu-Shin Street, Gueishan District, Taoyuan, 333, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
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8
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Mortaz E, Alipoor SD, Adcock IM, Mumby S, Koenderman L. Update on Neutrophil Function in Severe Inflammation. Front Immunol 2018; 9:2171. [PMID: 30356867 PMCID: PMC6190891 DOI: 10.3389/fimmu.2018.02171] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/03/2018] [Indexed: 12/17/2022] Open
Abstract
Neutrophils are main players in the effector phase of the host defense against micro-organisms and have a major role in the innate immune response. Neutrophils show phenotypic heterogeneity and functional flexibility, which highlight their importance in regulation of immune function. However, neutrophils can play a dual role and besides their antimicrobial function, deregulation of neutrophils and their hyperactivity can lead to tissue damage in severe inflammation or trauma. Neutrophils also have an important role in the modulation of the immune system in response to severe injury and trauma. In this review we will provide an overview of the current understanding of neutrophil subpopulations and their function during and post-infection and discuss the possible mechanisms of immune modulation by neutrophils in severe inflammation.
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Affiliation(s)
- Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shamila D Alipoor
- Molecular Medicine Department, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Ian M Adcock
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sharon Mumby
- Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Leo Koenderman
- Laboratory of Translational Immunology, Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
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9
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Larsen FF, Petersen JA. Novel biomarkers for sepsis: A narrative review. Eur J Intern Med 2017; 45:46-50. [PMID: 28965741 DOI: 10.1016/j.ejim.2017.09.030] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sepsis is a prevalent condition among hospitalized patients that carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, so effective treatment can be initiated rapidly. Traditionally, diagnosis was based on presence of two or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exist, and clinicians still rely on a number of traditional and novel biomarkers to discriminate between patients with and without infection, as the cause of deterioration. METHOD Narrative review of current literature. RESULTS A number of the most promising biomarkers for diagnoses and prognostication of sepsis are presented. CONCLUSION Procalcitonin, presepsin, CD64, suPAR, and sTREM-1 are the best evaluated biomarkers for diagnosis and prognostication of sepsis to date. All have limitations in differentiation between infected and non-infected patients with SIRS, and their future role in diagnosis needs to be evaluated. It is important to test utility, performance, and validity of future biomarkers before implementing them in routine clinical care.
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Affiliation(s)
| | - J Asger Petersen
- Department of Day Surgery, Hvidovre Hospital, Kettegaards Alle 30, 2650 Hvidovre, Denmark.
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10
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de Jong E, de Lange DW, Beishuizen A, van de Ven PM, Girbes ARJ, Huisman A. Neutrophil CD64 expression as a longitudinal biomarker for severe disease and acute infection in critically ill patients. Int J Lab Hematol 2016; 38:576-84. [PMID: 27565453 DOI: 10.1111/ijlh.12545] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neutrophilic granulocytes express cluster of differentiation 64 (CD64) antigen upon activation. CD64 can be used as a marker of bacterial infection and sepsis. The goal of this study was to determine whether CD64 is a useful biomarker for critically ill patients and analyze longitudinal measurements with regard to outcome and sepsis severity. METHODS In this prospective observational study, CD64 analysis was performed daily until discharge from ICU or death. Demographics, clinical, laboratory data, and outcome defined as 28-day survival were recorded. Patients were included when admitted to the ICU with sepsis, severe sepsis, or septic shock and within 24 h from start of antibiotic treatment. RESULTS Hundred and fifty-five consecutive patients were enrolled. At baseline, a difference in CD64 of 2.26 (1.33-4.47) vs. 1.49 (0.89-2.24) (P = 0.004) was seen between patients with a positive culture and negative culture. CD64 at day 1 was higher with patients with septic shock when compared with sepsis (P = 0.012). No difference of CD64 between survivors and nonsurvivors was seen. CONCLUSION This study demonstrated that CD64 discriminates between critically ill patients with culture positive and negative sepsis and correlates with severity of disease. However, CD64 index is not a good predictor for 28-day mortality in the critically ill patient.
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Affiliation(s)
- E de Jong
- Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - D W de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Beishuizen
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.,Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - P M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - A R J Girbes
- Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - A Huisman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
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11
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Development of a Modular Assay for Detailed Immunophenotyping of Peripheral Human Whole Blood Samples by Multicolor Flow Cytometry. Int J Mol Sci 2016; 17:ijms17081316. [PMID: 27529227 PMCID: PMC5000713 DOI: 10.3390/ijms17081316] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/18/2016] [Accepted: 07/28/2016] [Indexed: 12/19/2022] Open
Abstract
The monitoring of immune cells gained great significance in prognosis and prediction of therapy responses. For analyzing blood samples, the multicolor flow cytometry has become the method of choice as it combines high specificity on single cell level with multiple parameters and high throughput. Here, we present a modular assay for the detailed immunophenotyping of blood (DIoB) that was optimized for an easy and direct application in whole blood samples. The DIoB assay characterizes 34 immune cell subsets that circulate the peripheral blood including all major immune cells such as T cells, B cells, natural killer (NK) cells, monocytes, dendritic cells (DCs), neutrophils, eosinophils, and basophils. In addition, it evaluates their functional state and a few non-leukocytes that also have been associated with the outcome of cancer therapy. This DIoB assay allows a longitudinal and close-meshed monitoring of a detailed immune status in patients requiring only 2.0 mL of peripheral blood and it is not restricted to peripheral blood mononuclear cells. It is currently applied for the immune monitoring of patients with glioblastoma multiforme (IMMO-GLIO-01 trial, NCT02022384), pancreatic cancer (CONKO-007 trial, NCT01827553), and head and neck cancer (DIREKHT trial, NCT02528955) and might pave the way for immune biomarker identification for prediction and prognosis of therapy outcome.
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Matt P, Lindqvist U, Kleinau S. Elevated Membrane and Soluble CD64: A Novel Marker Reflecting Altered FcγR Function and Disease in Early Rheumatoid Arthritis That Can Be Regulated by Anti-Rheumatic Treatment. PLoS One 2015; 10:e0137474. [PMID: 26406605 PMCID: PMC4583189 DOI: 10.1371/journal.pone.0137474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Fc receptors (FcR) interacting with immune complexes (ICs) is a central event in the immune pathogenesis of rheumatoid arthritis (RA). Here we asked if a specific FcR is linked to RA pathogenesis and if FcR activities relate to disease and treatment outcome in early RA. MATERIAL AND METHODS Twenty autoantibody-positive RA patients and 33 HC were included. The patients were evaluated before and after treatment with methotrexate and prednisolone. At follow-up, the EULAR response criteria were applied to determine the individual treatment outcomes. Serum immunoglobulin levels were measured and the expression of FcR for IgG (FcγR) and IgA (FcαR) on peripheral blood monocytes were determined by flow cytometry. The monocytic FcγR function was evaluated by human IgG1 and IgG3 IC-binding and TNFα stimulated release. Plasma levels of soluble FcRs (sFcRs) were determined with ELISA. RESULTS The IgG1 and IgG3 levels were elevated in the RA sera. The RA monocytes expressed more CD64 and cell surface-bound IgG than HC monocytes, and showed an impaired FcγR function as reflected by changes in IC-binding and decreased IC-stimulated TNFα secretion. These findings correlated significantly with different disease activity markers. Furthermore, sFcRs were elevated in the patient plasma, and sCD64 was specific for RA (compared with a reference group of patients with active psoriatic arthritis). Following treatment, immunoglobulins and sFcR levels were reduced, whereas membrane CD64 was only decreased in patients with good response to treatment. CONCLUSIONS Early RA patients display increased membrane and soluble CD64 and an impaired FcγR function correlating with joint disease activity. Beneficial responses of anti-rheumatic treatment in patients reduce CD64. These data suggest sCD64 as an important objective biomarker in RA.
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Affiliation(s)
- Peter Matt
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Ulla Lindqvist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sandra Kleinau
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
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Jämsä J, Huotari V, Savolainen ER, Syrjälä H, Ala-kokko T. Kinetics of leukocyte CD11b and CD64 expression in severe sepsis and non-infectious critical care patients. Acta Anaesthesiol Scand 2015; 59:881-91. [PMID: 25866876 DOI: 10.1111/aas.12515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/27/2014] [Accepted: 02/11/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Leukocyte surface molecules may improve sepsis diagnostics. Our aim was to study whether monocyte and neutrophil CD11b and CD64 expression differs between patients with severe sepsis (including septic shock) and intensive care unit (ICU) controls, and also to investigate the expression kinetics in patient groups. METHODS Monocyte and neutrophil CD11b and CD64 expression was analyzed in 27 patients with severe sepsis, 7 off-pump coronary artery bypass (OPCAB) patients, and 8 ICU patients without systemic inflammation in the beginning of the treatment using quantitative flow cytometry. Blood samples were collected within 48 h of the beginning of severe sepsis, at admission to the ICU for non-systemic inflammatory response syndrome patients, and on the day of surgery before the skin incision for OPCAB patients, and on 2 consecutive days for all patients. Ten healthy individuals served as controls. RESULTS Monocyte and neutrophil CD11b and neutrophil CD64 expression was higher in severe sepsis patients compared with the other groups (P < 0.05). In severe sepsis, the expression decreased over time (P < 0.05). In OPCAB patients, the monocyte and neutrophil CD64 expression increased after surgery (P < 0.05). Neutrophil CD64 expression had the highest and statistically significant area under curves (AUC) values for identification of severe sepsis during 3 consecutive days, the highest AUC being 0.990 on D0. CONCLUSION Neutrophil CD64 as well as neutrophil and monocyte CD11b expressions were highest in severe sepsis compared with non-infectious conditions, and thus analyses of their expression may be promising approach for sepsis diagnosis in ICU population.
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Affiliation(s)
- J. Jämsä
- Department of Anaesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - V. Huotari
- NordLab Oulu; Oulu University Hospital; Medical Research Center Oulu; Department of Clinical Chemistry; University of Oulu; Oulu Finland
| | - E.-R. Savolainen
- NordLab Oulu; Oulu University Hospital; Medical Research Center Oulu; Department of Clinical Chemistry; University of Oulu; Oulu Finland
| | - H. Syrjälä
- Department of Infection Control; Oulu University Hospital; Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - T. Ala-kokko
- Department of Anaesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Medical Research Center Oulu; University of Oulu; Oulu Finland
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Titova E, Aune MW, Fonn K, Henriksen AH, Åsberg A. Neutrophil CD64 Expression as a Diagnostic Marker in Patients Hospitalized with Exacerbations of COPD: A Prospective Observational Study. Lung 2015; 193:717-24. [PMID: 26174093 DOI: 10.1007/s00408-015-9762-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/01/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The expression of the neutrophil high-affinity Fc-gamma receptor (CD64) can be used as a diagnostic marker for bacterial infection and sepsis. The aims of this study were to determine the diagnostic accuracy of CD64 compared to C-reactive protein (CRP) and white blood cell count (WBC) in patients hospitalized with acute exacerbations of COPD (AECOPD) and to investigate the kinetics of CD64 expression. METHODS The present study is a prospective, single-centre observation study. Blood samples were collected from patients hospitalized with AECOPD at admission and after 6, 24 and 48 h. Retrospective reviews on the patients' medical records were performed blinded to the CD64 results. The CD64 was measured using the Leuko64 kit from Trillium Diagnostics, LLC (Maine, USA) with the CELL-DYN Sapphire Haematology System (Abbott Laboratories, Illinois, USA). Diagnostic accuracy of the CD64, CRP and WBC was compared using a receiver operating characteristic (ROC) curve analysis. RESULTS A total of 113 patients were included. Thirty-six patients (32 %) had pulmonary infiltrate on chest X-ray at admission (PI). The CD64 was higher in samples from patients with AECOPD and PI than those without PI at admission (median 1.25 vs. 0.60, p = 0.002) and during 48 h of follow-up. The area under the ROC curve of CD64, CRP and WBC was 0.69, 0.73 and 0.64, respectively, (p = 0.42 for the test of difference). CONCLUSION Neutrophil CD64 expression has about the same diagnostic accuracy as CRP in diagnosing pneumonia in patients hospitalized with AECOPD, but does not add to the diagnostic accuracy of CRP and WBC count.
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Affiliation(s)
- Elena Titova
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7006, Trondheim, Norway. .,Department of Thoracic Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Marthe Wedø Aune
- Department of Immunology and Transfusion Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Kristin Fonn
- Department of Immunology and Transfusion Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7006, Trondheim, Norway. .,Department of Thoracic Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Arne Åsberg
- Department of Clinical Chemistry, Trondheim University Hospital, Trondheim, 7006, Norway.
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Pradhan R, Jain P, Paria A, Saha A, Sahoo J, Sen A, Mukherjee S, Som T, Hazra A, Warner N, Singh AK, Chatterjee M. Ratio of neutrophilic CD64 and monocytic HLA-DR: A novel parameter in diagnosis and prognostication of neonatal sepsis. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:295-302. [DOI: 10.1002/cyto.b.21244] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Richeek Pradhan
- Department of Pharmacology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Paresh Jain
- BD Biosciences India Gurgaon; Haryana 122001 India
| | - Anshuman Paria
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Anindya Saha
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Jagdish Sahoo
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Anway Sen
- Department of Pathology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Suchandra Mukherjee
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Tapas Som
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Avijit Hazra
- Department of Pharmacology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Noel Warner
- BD Biosciences San Jose; San Jose California 95131
| | - Arun K Singh
- Department of Neonatology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
| | - Mitali Chatterjee
- Department of Pharmacology; Institute of Postgraduate Medical Education & Research; 244 B Acharya JC Bose Road Kolkata 700 020 India
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Righi S, Santambrogio L, Monsagrati A, Saliu M, Locati L, Radrizzani D. Clinical Evaluation of Neutrophil CD64 as a Diagnostic Marker of Infection in a Polyvalent Intensive Care Unit. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e31828f4b6a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Gibot S, Béné MC, Noel R, Massin F, Guy J, Cravoisy A, Barraud D, De Carvalho Bittencourt M, Quenot JP, Bollaert PE, Faure G, Charles PE. Combination biomarkers to diagnose sepsis in the critically ill patient. Am J Respir Crit Care Med 2012; 186:65-71. [PMID: 22538802 DOI: 10.1164/rccm.201201-0037oc] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
RATIONALE Although the outcome of sepsis benefits from the prompt administration of appropriate antibiotics on correct diagnosis, the assessment of infection in critically ill patients is often a challenge for clinicians. In this setting, simple biomarkers, especially when used in combination, could prove useful. OBJECTIVES To determine the usefulness of combination biomarkers to diagnose sepsis. METHODS Three hundred consecutive patients were enrolled to construct a biologic score that was next validated in an independent prospective cohort of 79 critically ill patients from another center. MEASUREMENT AND MAIN RESULTS Plasma concentrations of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) were assayed, and the expression of the high-affinity immunoglobulin-Fc fragment receptor I (FcγRI) CD64 on neutrophils (polymorphonuclear [PMN] CD64 index) in flow cytometry was measured. A "bioscore" combining these biomarkers was constructed. Serum concentrations of PCT and sTREM-1 and the PMN CD64 index were higher in patients with sepsis compared with all others (P < 0.001 for the three markers). These biomarkers were all independent predictors of infection, the best receiver-operating characteristic curve being obtained for the PMN CD64 index. The performance of the bioscore, better than that of each individual biomarker, was externally confirmed in the validation cohort. CONCLUSIONS This prospective study, including inceptive and validation cohorts of unselected intensive care unit patients, demonstrates the high performance of a bioscore combining the PMN CD64 index together with PCT and sTREM-1 serum levels in diagnosing sepsis in the critically ill patient.
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Affiliation(s)
- Sébastien Gibot
- Hôpital Central, Service de Réanimation Médicale, 29 avenue du Maréchal de Lattre de Tassigny, Nancy Cedex, France.
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Gámez-Díaz LY, Enriquez LE, Matute JD, Velásquez S, Gómez ID, Toro F, Ospina S, Bedoya V, Arango CM, Valencia ML, De La Rosa G, Gómez CI, García A, Patiño PJ, Jaimes FA. Diagnostic accuracy of HMGB-1, sTREM-1, and CD64 as markers of sepsis in patients recently admitted to the emergency department. Acad Emerg Med 2011; 18:807-15. [PMID: 21762470 DOI: 10.1111/j.1553-2712.2011.01113.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The objectives were to evaluate the diagnostic accuracy for sepsis in an emergency department (ED) population of the cluster of differentiation-64 (CD64) glycoprotein expression on the surface of neutrophils (nCD64), serum levels of soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1), and high-mobility group box-1 protein (HMGB-1). METHODS Patients with any of the following as admission diagnosis were enrolled: 1) suspected infection, 2) fever, 3) delirium, or 4) acute hypotension of unexplained origin within 24 hours of ED presentation. Levels of nCD64, HMGB-1, and s-TREM-1 were measured within the first 24 hours of the first ED evaluation. Baseline clinical data, Sepsis-related Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, daily clinical and microbiologic information, and 28-day mortality rate were collected. Because there is not a definitive criterion standard for sepsis, the authors used expert consensus based on clinical, microbiologic, laboratory, and radiologic data collected for each patient during the first 7 days of hospitalization. This expert consensus defined the primary outcome of sepsis, and the primary data analysis was based in the comparison of sepsis versus nonsepsis patients. The cut points to define sensitivity and specificity values, as well as positive and negative likelihood ratios (LRs) for the markers related to sepsis diagnosis, were determined using receiver operative characteristics (ROC) curves. The patients in this study were a prespecified nested subsample population of a larger study. RESULTS Of 631 patients included in the study, 66% (95% confidence interval [CI] = 62% to 67%, n = 416) had sepsis according with the expert consensus diagnosis. Among these sepsis patients, SOFA score defined 67% (95% CI = 62% to 71%, n = 277) in severe sepsis and 1% (95% CI = 0.3% to 3%, n = 6) in septic shock. The sensitivities for sepsis diagnosis were CD64, 65.8% (95% CI = 61.1% to 70.3%); HMGB-1, 57.5% (95% CI = 52.7% to 62.3%); and s-TREM-1, 60% (95% CI = 55.2% to 64.7%). The specificities were CD64, 64.6% (95% CI = 57.8% to 70.8%), HMGB-1, 57.8% (95% CI = 51.1% to 64.3%), and s-TREM-1, 59.2% (95% CI = 52.5% to 65.6%). The positive LR (LR+) for CD64 was 1.85 (95% CI = 1.52 to 2.26) and the negative LR (LR-) was 0.52 (95% CI = 0.44 to 0.62]; for HMGB-1 the LR+ was 1.36 (95% CI = 1.14 to 1.63) and LR- was 0.73 (95% CI = 0.62 to 0.86); and for s-TREM-1 the LR+ was 1.47 (95% CI = 1.22 to 1.76) and the LR- was 0.67 (95% CI = 0.57 to 0.79). CONCLUSIONS In this cohort of patients suspected of having any infection in the ED, the accuracy of nCD64, s-TREM-1, and HMGB-1 was not significantly sensitive or specific for diagnosis of sepsis.
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Affiliation(s)
- Laura Y Gámez-Díaz
- Group of Primary Immunodeficiencies, University of Antioquia, Medellín, Colombia
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Mittal R, Sukumaran SK, Selvaraj SK, Wooster DG, Babu MM, Schreiber AD, Verbeek JS, Prasadarao NV. Fcγ receptor I alpha chain (CD64) expression in macrophages is critical for the onset of meningitis by Escherichia coli K1. PLoS Pathog 2010; 6:e1001203. [PMID: 21124939 PMCID: PMC2987830 DOI: 10.1371/journal.ppat.1001203] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 10/21/2010] [Indexed: 11/18/2022] Open
Abstract
Neonatal meningitis due to Escherichia coli K1 is a serious illness with unchanged morbidity and mortality rates for the last few decades. The lack of a comprehensive understanding of the mechanisms involved in the development of meningitis contributes to this poor outcome. Here, we demonstrate that depletion of macrophages in newborn mice renders the animals resistant to E. coli K1 induced meningitis. The entry of E. coli K1 into macrophages requires the interaction of outer membrane protein A (OmpA) of E. coli K1 with the alpha chain of Fcγ receptor I (FcγRIa, CD64) for which IgG opsonization is not necessary. Overexpression of full-length but not C-terminal truncated FcγRIa in COS-1 cells permits E. coli K1 to enter the cells. Moreover, OmpA binding to FcγRIa prevents the recruitment of the γ-chain and induces a different pattern of tyrosine phosphorylation of macrophage proteins compared to IgG2a induced phosphorylation. Of note, FcγRIa−/− mice are resistant to E. coli infection due to accelerated clearance of bacteria from circulation, which in turn was the result of increased expression of CR3 on macrophages. Reintroduction of human FcγRIa in mouse FcγRIa−/− macrophages in vitro increased bacterial survival by suppressing the expression of CR3. Adoptive transfer of wild type macrophages into FcγRIa−/− mice restored susceptibility to E. coli infection. Together, these results show that the interaction of FcγRI alpha chain with OmpA plays a key role in the development of neonatal meningitis by E. coli K1. Escherichia coli K1 is the most common cause of meningitis in premature infants; the mortality rate of this disease ranges from 5% to 30%. A better understanding of the pathogenesis of E. coli K1 meningitis is needed to develop new preventative strategies. We have shown that outer membrane protein A (OmpA) of E. coli K1, independent of antibody opsonization, is critical for bacterial entrance and survival within macrophages. Using a newborn mouse model, we found that depletion of macrophages renders the animals resistant to E. coli K1 induced meningitis. OmpA binds to α-chain of Fcγ-receptor I (FcγRIa) in macrophages, but does not induce expected gamma chain association and signaling. FcγRIa knockout mice are resistant to E. coli K1 infection because their macrophages express more CR3 and are thus able to kill bacteria with greater efficiency, preventing the development of high-grade bacteremia, a pre-requisite for the onset of meningitis. These novel observations demonstrate that inhibiting OmpA binding to FcγRIa is a promising therapeutic target for treatment or prevention of neonatal meningitis.
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MESH Headings
- Animals
- Animals, Newborn
- Bacterial Outer Membrane Proteins/metabolism
- Binding, Competitive
- Blotting, Western
- Brain/immunology
- Brain/metabolism
- Brain/microbiology
- COS Cells
- Chlorocebus aethiops
- Escherichia coli/growth & development
- Escherichia coli/pathogenicity
- Flow Cytometry
- Humans
- Immunoglobulin G/immunology
- Immunoglobulin G/metabolism
- Immunoprecipitation
- Macrophage-1 Antigen/metabolism
- Macrophages/immunology
- Macrophages/metabolism
- Macrophages/microbiology
- Meningitis, Escherichia coli/etiology
- Meningitis, Escherichia coli/metabolism
- Meningitis, Escherichia coli/pathology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Nitric Oxide/metabolism
- Phagocytosis
- Phosphorylation
- RNA, Messenger/genetics
- Receptors, IgG/physiology
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- Rahul Mittal
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, United States of America
| | - Sunil K. Sukumaran
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, United States of America
| | - Suresh K. Selvaraj
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, United States of America
| | - David G. Wooster
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, United States of America
| | - M. Madan Babu
- Structural Studies Division, Medical Research Council, Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Alan D. Schreiber
- Hematology and Oncology Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - J. Sjef Verbeek
- Department of Human Genetics, University Medical Center, Leiden, Netherlands
| | - Nemani V. Prasadarao
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California, United States of America
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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Cid J, Aguinaco R, Sánchez R, García-Pardo G, Llorente A. Neutrophil CD64 expression as marker of bacterial infection: a systematic review and meta-analysis. J Infect 2010; 60:313-9. [PMID: 20206205 DOI: 10.1016/j.jinf.2010.02.013] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 02/08/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis of studies to evaluate the diagnostic accuracy of expression of CD64 on polymorphonuclear neutrophils (PMN) as a marker for bacterial infection. METHODS The analysis included studies of patients from all age groups that prospectively evaluated CD64 expression on PMNs for the diagnosis of bacterial infection. We evaluated the methodological quality of the studies according to the 25-item criteria developed by the Standards for Reporting of Diagnostic Accuracy (STARD) committee. We calculated a summary receiver operating characteristic (SROC) curve across studies included in the meta-analysis. RESULTS The methodological quality score of the 13 included studies ranged from 9 to 16 points (maximum score was 25 points). The pooled sensitivity and specificity for CD64 expression on PMNs were 79% (95% CI: 70-86%) and 91% (95% CI: 85-95%), respectively. The area under curve (AUC) was 0.94. CONCLUSIONS On the basis of this meta-analysis, CD64 expression on PMNs could be a useful diagnostic cell-based parameter of bacterial infections. However, published studies about this topic showed a low methodological quality.
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Affiliation(s)
- Joan Cid
- Haematology Service, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
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CD64 index provides simple and predictive testing for detection and monitoring of sepsis and bacterial infection in hospital patients. J Clin Microbiol 2009; 47:3914-9. [PMID: 19846647 DOI: 10.1128/jcm.00628-09] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The rapid diagnosis and management of bacterial infection are heavily dependent upon clinical assessment. Blood culture may take up to 2 days for results and may be suspect. Surface neutrophil CD64 expression has been shown to be upregulated in cases of bacterial infection. Recently, a standardized kit for the CD64 index was used in neonatal intensive care units, showing high sensitivity and specificity for bacterial infections. Our study was designed to confirm and extend these results to adult hospital patients and to determine the impact of this testing on a clinical laboratory's finances and staffing. CD64 indices were performed with peripheral blood drawn in tandem with blood cultures from 109 patients over a 2-month period. We found that a CD64 index of <or=1.19 was predictive of "no growth" blood culture results. An index of >1.19 was predictive of an ultimate clinical and/or culture diagnosis of infection with a sensitivity and specificity of 94.6% and 88.7%, respectively. Positive and negative predictive values were 89.8% and 94%, respectively. The CD64 index was easily performed using our flow cytometer and staff, producing minimal alteration in clinical workflow. A 7-day-a-week testing schedule will result in some additional expense but will be more than offset by the expected cost savings. The CD64 index is a useful and inexpensive test for improving the diagnosis and management of hospital patients with bacterial infection. It can be readily performed by clinical laboratories and could result in considerable savings for the institution.
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Hoffmann JJ. Neutrophil CD64: a diagnostic marker for infection and sepsis. Clin Chem Lab Med 2009; 47:903-16. [DOI: 10.1515/cclm.2009.224] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Neutrophil and monocyte CD64 and CD163 expression in critically ill neonates and children with sepsis: comparison of fluorescence intensities and calculated indexes. Mediators Inflamm 2008; 2008:202646. [PMID: 18604302 PMCID: PMC2442385 DOI: 10.1155/2008/202646] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/31/2008] [Accepted: 04/23/2008] [Indexed: 11/20/2022] Open
Abstract
Objective. To evaluate the expression of CD64 and CD163 on neutrophils and monocytes in SIRS with/without sepsis and to compare the diagnostic accuracy of CD64 and CD163 molecules expression determined as (1) mean fluorescence intensities (MFI) of CD64 and CD163; and (2) the ratio (index) of linearized MFI to the fluorescence signal of standardized beads. Patients and methods. Fifty-six critically ill neonates and children with systemic inflammatory response syndrome (SIRS) and suspected sepsis, classified into two groups: SIRS with sepsis (n = 29) and SIRS without sepsis (n = 27). Results. CD64 and CD163 MFI measured on neutrophils and monocytes were elevated in patients with SIRS with sepsis. Diagnostic accuracy of indexes was equal to diagnostic accuracy of MFI for CD64 on neutrophils (0.833 versus 0.854 for day 0 and 0.975 versus 0.983 for day 1) and monocytes (0.811 versus 0.865 for day 0 and 0.825 versus 0.858 for day 1), and CD163 on neutrophils (0.595 versus 0.655 for day 0 and 0.677 versus 0.750 for day 1), but not for CD163 on monocytes. Conclusion. CD64 MFI, CD163 MFI, CD64 indexes for neutrophils and monocytes, and CD163 index for neutrophils can all be used for discrimination of SIRS and sepsis in critically ill neonates and children. CD64 index for neutrophils, however, is superior to all other markers.
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Livaditi O, Kotanidou A, Psarra A, Dimopoulou I, Sotiropoulou C, Augustatou K, Papasteriades C, Armaganidis A, Roussos C, Orfanos SE, Douzinas EE. Neutrophil CD64 expression and serum IL-8: Sensitive early markers of severity and outcome in sepsis. Cytokine 2006; 36:283-90. [PMID: 17368039 DOI: 10.1016/j.cyto.2007.02.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 12/29/2006] [Accepted: 02/07/2007] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to investigate which biomarker/s reliably assess severity and mortality early in the sepsis process. In 47 critically-ill patients within the 24h of septic onset, Interleukins (IL)-8, -1beta, -6, -10, and -12p70, tumor necrosis factor-alpha (TNF-alpha), procalcitonin (PCT) and C-reactive protein (CRP) were measured in serum. Additionally, CD64 expression was measured in neutrophils. In early sepsis, neutrophil CD64 expression and IL-8 levels are the only biomarkers that increased with sepsis severity, differentiating disease stages: sepsis, severe sepsis and septic shock (p<0.001). The biomarkers that best evaluate the severity of sepsis (via APACHE II) were CD64, IL-8 and IL-6 (p<0.01), and the severity of organ failure (via SOFA) were CD64 and IL-8 (p<0.01). CD64 expression and IL-8 levels were associated with mortality within 28-days (OR=1.3, p=0.01 for CD64 and OR=1.26, p=0.024 for IL-8 by logistic regression analysis) and ROC curve analysis showed high sensitivity and specificity for predicting sepsis stages and the 28 day mortality. We conclude that there is an early increase of neutrophil CD64 expression and IL-8 levels during sepsis. Based on this single measurement it is possible to reliably assess the stage, detect the severity and predict the 28-day mortality of sepsis.
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Affiliation(s)
- Olga Livaditi
- 3rd (Evgenidion Hospital), Department of Critical Care, University of Athens Medical School, 20 Papadiamantopoulou St., Athens, 115 28, Greece
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Zarev PV, Davis BH. Comparative study of monocyte enumeration by flow cytometry: improved detection by combining monocyte-related antibodies with anti-CD163. ACTA ACUST UNITED AC 2004; 10:24-31. [PMID: 15070214 DOI: 10.1532/lh96.03056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Monocyte-counting performance by hematological cell counters often lacks satisfactory accuracy and precision. Flow cytometry, the alternative, is a reliable reference method for monocyte enumeration in evaluation of the performance of automated analyzers. The present study was focused on evaluation and optimization of monocyte enumeration by flow cytometry. Fifty blood samples were stained with same-color CD163, CD64, and CD14 monoclonal antibodies (MoAbs), single or in mixtures, along with different colors of anti-CD45 and anti-CD16. The percentage positive monocytes and their median fluorescence intensity (MFI) were compared between the resulting MoAb combinations. CD163(+)14 increased monocyte detection by 5% compared with CD14 alone. The CD64(+)CD163 mixture resulted in a 6% detection increase relative to CD64 alone. CD64(+)CD14 labeled 2% more monocytes than CD14 and 0.03% more compared with CD64. Combining CD14 with CD163 or CD64 increased MFI 24% and 14% relative to CD14. CD163(+)CD64 increased monocyte MFI 115% compared with CD64. We found that combining same-color antibodies improved monocyte detection, especially when anti-CD163 was added to CD64 or CD14 antibodies. The use of CD163 antibody is the recommended flow cytometric reference method for monocyte counting.
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Affiliation(s)
- Petar V Zarev
- Maine Medical Center Research Institute, Scarborough, Maine 04074, USA.
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