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Biomarkers for the Prediction and Judgement of Sepsis and Sepsis Complications: A Step towards precision medicine? J Clin Med 2022; 11:jcm11195782. [PMID: 36233650 PMCID: PMC9571838 DOI: 10.3390/jcm11195782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Sepsis and septic shock are a major public health concern and are still associated with high rates of morbidity and mortality. Whilst there is growing understanding of different phenotypes and endotypes of sepsis, all too often treatment strategies still only employ a “one-size-fits-all” approach. Biomarkers offer a unique opportunity to close this gap to more precise treatment approaches by providing insight into clinically hidden, yet complex, pathophysiology, or by individualizing treatment pathways. Predicting and evaluating systemic inflammation, sepsis or septic shock are essential to improve outcomes for these patients. Besides opportunities to improve patient care, employing biomarkers offers a unique opportunity to improve clinical research in patients with sepsis. The high rate of negative clinical trials in this field may partly be explained by a high degree of heterogeneity in patient cohorts and a lack of understanding of specific endotypes or phenotypes. Moving forward, biomarkers can support the selection of more homogeneous cohorts, thereby potentially improving study conditions of clinical trials. This may finally pave the way to a precision medicine approach to sepsis, septic shock and complication of sepsis in the future.
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Eichberger J, Resch E, Resch B. Diagnosis of Neonatal Sepsis: The Role of Inflammatory Markers. Front Pediatr 2022; 10:840288. [PMID: 35345614 PMCID: PMC8957220 DOI: 10.3389/fped.2022.840288] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 01/12/2023] Open
Abstract
This is a narrative review on the role of biomarkers in the diagnosis of neonatal sepsis. We describe the difficulties to obtain standardized definitions in neonatal sepsis and discuss the limitations of published evidence of cut-off values and their sensitivities and specificities. Maternal risk factors influence the results of inflammatory markers as do gestational age, the time of sampling, the use of either cord blood or neonatal peripheral blood, and some non-infectious causes. Current evidence suggests that the use of promising diagnostic markers such as CD11b, CD64, IL-6, IL-8, PCT, and CRP, either alone or in combination, might enable clinicians discontinuing antibiotics confidently within 24-48 h. However, none of the current diagnostic markers is sensitive and specific enough to support the decision of withholding antibiotic treatment without considering clinical findings. It therefore seems to be justified that antibiotics are often initiated in ill term and especially preterm infants. Early markers like IL-6 and later markers like CRP are helpful in the diagnosis of neonatal sepsis considering the clinical aspect of the neonate, the gestational age, maternal risk factors and the time (age of the neonate regarding early-onset sepsis) of blood sampling.
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Affiliation(s)
- Julia Eichberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Zhai X, Feng M, Guo H, Liang Z, Wang Y, Qin Y, Wu Y, Zhao X, Gao C, Luo J. Development of Prediction Models for New Integrated Models and a Bioscore System to Identify Bacterial Infections in Systemic Lupus Erythematosus. Front Cell Infect Microbiol 2021; 11:620372. [PMID: 33732661 PMCID: PMC7957015 DOI: 10.3389/fcimb.2021.620372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Distinguishing flares from bacterial infections in systemic lupus erythematosus (SLE) patients remains a challenge. This study aimed to build a model, using multiple blood cells and plasma indicators, to improve the identification of bacterial infections in SLE. Design Building PLS-DA/OPLS-DA models and a bioscore system to distinguish bacterial infections from lupus flares in SLE. Setting Department of Rheumatology of the Second Hospital of Shanxi Medical University. Participants SLE patients with flares (n = 142) or bacterial infections (n = 106) were recruited in this retrospective study. Outcome The peripheral blood of these patients was collected by the experimenter to measure the levels of routine examination indicators, immune cells, and cytokines. PLS-DA/OPLS-DA models and a bioscore system were established. Results Both PLS-DA (R2Y = 0.953, Q2 = 0.931) and OPLS-DA (R2Y = 0.953, Q2 = 0.942) models could clearly identify bacterial infections in SLE. The white blood cell (WBC), neutrophile granulocyte (NEUT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), IL-10, interferon-γ (IFN-γ), and tumor necrosis factor α (TNF-α) levels were significantly higher in bacteria-infected patients, while regulatory T (Treg) cells obviously decreased. A multivariate analysis using the above 10 dichotomized indicators, based on the cut-off value of their respective ROC curve, was established to screen out the independent predictors and calculate their weights to build a bioscore system, which exhibited a strong diagnosis ability (AUC = 0.842, 95% CI 0.794–0.891). The bioscore system showed that 0 and 100% of SLE patients with scores of 0 and 8–10, respectively, were infected with bacteria. The higher the score, the greater the likelihood of bacterial infections in SLE. Conclusions The PLS-DA/OPLS-DA models, including the above biomarkers, showed a strong predictive ability for bacterial infections in SLE. Combining WBC, NEUT, CRP, PCT, IL-6, and IFN-γ in a bioscore system may result in faster prediction of bacterial infections in SLE and may guide toward a more appropriate, timely treatment for SLE.
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Affiliation(s)
- Xvwen Zhai
- Clinical Skills Teaching Simulation Hospital, Shanxi Medical University, Jinzhong, China
| | - Min Feng
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Guo
- Division of Nephrology, Department of Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, China.,Division of Nephrology, Department of Medicine, The Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Zhaojun Liang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanlin Wang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Qin
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanyao Wu
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiangcong Zhao
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chong Gao
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jing Luo
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
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ELMeneza S, Mohamed W, Elbagoury I, Bahagat K. Role of neutrophil CD11b expression in diagnosis of earlyonset neonatal sepsis in full-term infant. Clin Exp Pediatr 2021; 64:44-45. [PMID: 32299179 PMCID: PMC7806405 DOI: 10.3345/cep.2019.01319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/08/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Safaa ELMeneza
- Department of Pediatrics, Faculty of Medicine for Girls, ALAzhar University, Cairo, Egypt
| | - Walaa Mohamed
- Department of Pediatrics, Faculty of Medicine for Girls, ALAzhar University, Cairo, Egypt
| | - Iman Elbagoury
- Department of Clinical pathology, Faculty of Medicine for Girls, AL-Azhar University, Cairo, Egypt
| | - Karima Bahagat
- Department of Pediatrics, Faculty of Medicine for Girls, ALAzhar University, Cairo, Egypt
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Murthy S, Godinho MA, Guddattu V, Lewis LES, Nair NS. Risk factors of neonatal sepsis in India: A systematic review and meta-analysis. PLoS One 2019; 14:e0215683. [PMID: 31022223 PMCID: PMC6483350 DOI: 10.1371/journal.pone.0215683] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/06/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The incidence of neonatal sepsis in India is the highest in the world. Evidence regarding its risk factors can guide clinical practice and prevention strategies. OBJECTIVE To review, assess and synthesize the available literature from India on the risk factors of sepsis among neonates. METHODOLOGY A systematic review was conducted. We searched PubMed, CINAHL, Scopus, Web of Science, Popline, IndMed, Indian Science Abstracts and Google Scholar from inception up to March 23, 2018 to identify observational analytical studies reporting on risk factors of laboratory-confirmed neonatal sepsis in India. Two authors independently screened studies (title, abstract and full-text stages), extracted data, and assessed quality. A random-effects meta-analysis was performed as substantial heterogeneity was anticipated. Subgroup and sensitivity analyses were additionally performed. Effect size in our review included odds ratio and standardized mean difference. RESULTS Fifteen studies were included from 11,009 records, of which nine were prospective in design. Birthweight and gestational age at delivery were the most frequently reported factors. On meta-analyses, it was found that male sex (OR: 1.3, 95% CI: 1.02, 1.68), out born neonates (OR: 5.5, 95% CI: 2.39, 12.49), need for artificial ventilation (OR: 5.61; 95% CI: 8.21, 41.18), gestational age <37 weeks (OR: 2.05; 95% CI:1.40, 2.99) and premature rupture of membranes (OR:11.14, 95% CI: 5.54, 22.38) emerged as risk factors for neonatal sepsis. Included studies scored lowest on exposure assessment and confounding adjustment, which limited comparability. Inadequacy and variation in definitions and methodology affected the quality of included studies and increased heterogeneity. CONCLUSIONS Male neonates, outborn admissions, need for artificial ventilation, gestational age <37 weeks and premature rupture of membranes are risk factors for sepsis among neonates in India. Robustly designed and reported research is urgently needed to confirm the role of other risk factors of neonatal sepsis in India.
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Affiliation(s)
- Shruti Murthy
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Myron Anthony Godinho
- WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Vasudeva Guddattu
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Leslie Edward Simon Lewis
- Department of Paediatrics, Neonatology Unit, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - N. Sreekumaran Nair
- Department of Medical Biometrics & Informatics (Biostatistics), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Feng M, Zhang SL, Liang ZJ, Wang YL, Zhao XC, Gao C, Guo H, Luo J. Peripheral neutrophil CD64 index combined with complement, CRP, WBC count and B cells improves the ability of diagnosing bacterial infection in SLE. Lupus 2019; 28:304-316. [PMID: 30712491 DOI: 10.1177/0961203319827646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the diagnostic role of complement C3, complement C4, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), neutrophil CD64 (nCD64) index, lymphocyte subsets and their combination in differentiating bacterial infection from disease relapse in systemic lupus erythematosus (SLE). METHODS The above biomarkers in 36 hospitalized SLE patients with bacterial infection and 45 with lupus flare without infection were retrospectively studied. Bacterial infection was proven by positive cultures or typical clinical symptoms and signs combined with positive response to antibiotics. Lupus flare was defined as three points greater than their previous SLE disease activity index score. The diagnostic value for bacterial infection was evaluated by the areas under the receiver operating characteristic curves (AUC) and a novel bioscore system combining multiple biomarkers. RESULTS Increased CRP ( p = 0.049), WBC ( p = 0.028) and nCD64 index ( p = 0.034) were observed in the infected group and C3 ( p = 0.001), C4 ( p = 0.016) and B cells levels ( p = 0.010) were significantly reduced. The AUC for the above six biomarkers had no significant difference. Interestingly, the combination of nCD64 index, CRP, WBC, C3 and C4 improved significantly the diagnostic potential of SLE infection (AUC 0.783 (interquartile range 0.672, 0.871), p < 0.001; sensitivity 85.29% specificity 62.50%). In the bioscore system including the above six biomarkers, the bacterial infection rate in patients with bioscore ≤2, 3, 4, 5 and 6 were 0.00, 39.29, 59.10, 61.54 and 100.00%, respectively. CONCLUSION The combination of nCD64 index, C3, C4, CRP, WBC and B cells in a bioscore is useful to diagnose bacterial infection in SLE.
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Affiliation(s)
- M Feng
- 1 Shanxi Medical University, Taiyuan, Shanxi, China
| | - S L Zhang
- 2 Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Z J Liang
- 1 Shanxi Medical University, Taiyuan, Shanxi, China
| | - Y L Wang
- 1 Shanxi Medical University, Taiyuan, Shanxi, China
| | - X C Zhao
- 3 Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - C Gao
- 4 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - H Guo
- 5 Division of Nephrology, Department of Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.,6 Division of Nephrology, Department of Medicine, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - J Luo
- 3 Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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El-Madbouly AA, El Sehemawy AA, Eldesoky NA, Abd Elgalil HM, Ahmed AM. Utility of presepsin, soluble triggering receptor expressed on myeloid cells-1, and neutrophil CD64 for early detection of neonatal sepsis. Infect Drug Resist 2019; 12:311-319. [PMID: 30774398 PMCID: PMC6357881 DOI: 10.2147/idr.s191533] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Neonatal sepsis (NS) is an important cause of morbidity and mortality among newborns. Its diagnosis depends mainly on blood culture that takes at least 48 hours to give results. Therefore, searching for biomarkers for early diagnosis is of value. We aimed to assess presepsin, soluble triggering receptor expressed on myeloid cells (sTREM-1), and neutrophil CD64 (nCD64) as early diagnostic biomarkers in NS, and to compare them individually and in combination. Methods This hospital-based case–control study has been conducted on 60 full-term neonates recruited from the neonatal intensive care unit, Al-Zahraa Hospital, Al-Azhar University, Cairo, Egypt. Thirty infants with sepsis were compared to 30 postnatal age- and sex-matched healthy controls. Studied neonates were evaluated using clinical and laboratory indicators for sepsis. nCD64 was measured by flow cytometry and, serum presepsin and sTREM-1 were measured by ELISA. Results Presepsin, sTREM-1, and nCD64 levels were significantly elevated in septic neonates vs control group (P<0.05). The sensitivities of presepsin, sTREM, and nCD64 were 100%, 96.7%, and 86.7%, respectively. Presepsin had the best diagnostic performance in early diagnosis of NS followed by sTREM-1 and nCD64. Conclusion Presepsin and sTREM-1 are promising biomarkers in screening for NS in comparison with nCD64. However, nCD64 is better used in combination with other biomarkers as CRP.
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Affiliation(s)
- Asmaa A El-Madbouly
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Asmaa A El Sehemawy
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Noha A Eldesoky
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Heba Mohammed Abd Elgalil
- Community and Occupational Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
| | - Amal M Ahmed
- Community and Occupational Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
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8
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Examining the utility of the CD64 index compared with other conventional indices for early diagnosis of neonatal infection. Sci Rep 2018; 8:9994. [PMID: 29968788 PMCID: PMC6030194 DOI: 10.1038/s41598-018-28352-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/20/2018] [Indexed: 02/08/2023] Open
Abstract
As specific clinical manifestations and detection tools for early neonatal infections are lacking, early detection and treatment are ongoing challenges. The present study aimed to investigate the role and clinical significance of the CD64 index in comparison with conventional examination indices (WBC, PCT and CRP) for the early diagnosis of neonatal infection. Of 74 in-patient newborns, non-sepsis (non-specific infection but free of sepsis), sepsis and control [newborns with ABO hemolytic disease of the newborn (ABOHDN) but without infection] groups involved 32, 16 and 26 cases, respectively. Peripheral blood WBC, PCT, CRP and CD64 indices were acquired for all groups. The sepsis group showed significantly higher WBC, PCT and CRP levels than the control group. Compared with the non-sepsis group, the sepsis group demonstrated significant increases in PCT but not in WBC or CRP. Compared with the control group, the non-sepsis and sepsis groups had higher CD64 indices. Combined, compared with the WBC, PCT and CRP indices, the CD64 index is unique in its capacity to diagnose neonatal infections early. The CD64 index combined with other conventional indices may lay a basis for the future early diagnosis and effective treatment of neonatal infections.
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Halek J, Novak M, Medkova A, Furst T, Juranova J. The role of nCD64 in the diagnosis of neonatal sepsis in preterm newborns. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:284-288. [PMID: 29955185 DOI: 10.5507/bp.2018.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diagnosing neonatal sepsis is difficult, particularly in preterm newborns. A promising method appears to be evaluation of cell surface markers by flow cytometry. METHODS This prospective study investigated 217 newborns suspected of having early- or late-onset neonatal sepsis. In all, flow cytometry was used to determine the proportion of CD64-positive neutrophils (nCD64). Based on the clinical course and laboratory test results, newborns were categorized as having proven, possible, clinical or no neonatal sepsis. Subsequently, associations between the categories and nCD64 values were analyzed. RESULTS There were significant associations between nCD64 values and the development of sepsis in newborns with both early- or late-onset sepsis. CONCLUSION nCD64expression is significantly elevated in preterm newborn with early and late onset sepsis. The results show that nCD64 is a reliable marker for diagnosing neonatal sepsis.
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Affiliation(s)
- Jan Halek
- Neonatal Ward and Department of Pediatrics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Novak
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Anna Medkova
- Neonatal Ward and Department of Pediatrics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Tomas Furst
- Department of Mathematical Analysis and Mathematical Applications, Faculty of Science, Palacky University Olomouc, Czech Republic
| | - Jarmila Juranova
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Wen X, Han X, Wang Y, Fan S, Zhang Z, Wu D, Lu J, Zheng Y. Retracted
: Effects of S100A12 gene silencing on serum levels of anti‐inflammatory/pro‐inflammatory cytokines in septic rats through the ERK signaling pathway. J Cell Biochem 2018; 119:4038-4049. [DOI: 10.1002/jcb.26568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Xin Wen
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Xin‐Rui Han
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Yong‐Jian Wang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Shao‐Hua Fan
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Zi‐Feng Zhang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Dong‐Mei Wu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Jun Lu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
| | - Yuan‐Lin Zheng
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu ProvinceSchool of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
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Morquin D, Tuaillon E, Makinson A, Bendriss S, Le Moing V, Reynes J. Impact of T cell activation, HIV replication and hepatitis C virus infection on neutrophil CD64 expression. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:492-497. [PMID: 27221825 DOI: 10.1002/cyto.b.21385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Overexpression of the Fc receptor CD64 on neutrophils is associated with innate immune response and bacterial infections. During HIV infection a large set of immune disorders including T-lymphocyte over-activation, microbial translocation, impairment of neutrophil functions, and immunodeficiency may interplay with neutrophil CD64 expression. METHODS Associations of neutrophil CD64 expression with CD8+ T cell activation, CD4+ T cells number, HIV, and HCV replications were investigated in HIV infected patients using a standardized method. RESULTS Higher neutrophil CD64 expression was observed in HIV infected subjects compared to healthy controls (0.91 vs. 0.75, P < 0.001). Among 115 HIV infected patients, nine (8.8%) had a CD64 expression over the clinical threshold as calculated against bead standard (i.e., 1.5). HIV viremic patients were more likely to have an index above 1.5 (OR: 6.68, P values: 0.01). A trend for correlation between CD64 expression and CD8 T cell activation was observed (P values: 0.08). Blood CD4+ T lymphocyte depletion and HCV replication did not affect neutrophil CD64 expression. CONCLUSIONS HIV infection and HIV replication are associated with up-regulation of neutrophil CD64. CD64 overexpression above the clinical threshold was observed in a minor proportion of HIV infected individuals treated by antiretroviral therapy and may be a marker of neutrophil activation related to non-AIDS-linked comorbidities. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- D Morquin
- Infectious and Tropical Diseases Department, UMI 233, Gui De Chauliac, University Hospital of Montpellier, Montpellier, France
| | - E Tuaillon
- Infectious and Tropical Diseases Department, UMI 233, Gui De Chauliac, University Hospital of Montpellier, Montpellier, France.,Department of Microbiology, Université Montpellier 1/Inserm UMR 1058, Lapeyronie, University Hospital of Montpellier, Montpellier, France
| | - A Makinson
- Infectious and Tropical Diseases Department, UMI 233, Gui De Chauliac, University Hospital of Montpellier, Montpellier, France
| | - S Bendriss
- Department of Microbiology, Université Montpellier 1/Inserm UMR 1058, Lapeyronie, University Hospital of Montpellier, Montpellier, France
| | - V Le Moing
- Infectious and Tropical Diseases Department, UMI 233, Gui De Chauliac, University Hospital of Montpellier, Montpellier, France
| | - J Reynes
- Infectious and Tropical Diseases Department, UMI 233, Gui De Chauliac, University Hospital of Montpellier, Montpellier, France
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Doi T, Doi T, Kawamura N, Matsui T, Komiya A, Tei Z, Niitsuma G, Kunogi J. The usefulness of neutrophil CD64 expression for diagnosing infection after orthopaedic surgery in dialysis patients. J Orthop Sci 2016; 21:546-551. [PMID: 27188928 DOI: 10.1016/j.jos.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/29/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dialysis patients undergoing orthopaedic surgery are at high risk for postoperative infection. Diagnosis of postoperative infection is difficult in dialysis patients due to presentation of signs and symptoms similar to infection, such as fever and elevated inflammatory marker levels. Neutrophil CD64 expression (CD64), a marker of infection, is upregulated by microbial wall components and several cytokines (interferon-γ and tumor necrosis factor-α). The purpose of this study is to evaluate the usefulness of CD64 for diagnosing postoperative infection in dialysis patients post orthopaedic surgery. PATIENTS AND METHODS Between 2013 and 2014, we prospectively studied 36 dialysis patients (18 men, 18 women; mean age 65.9 years; 49 to 83) who underwent orthopaedic surgery. Dialysis patients were classified into three groups according to their postoperative course as follows; non-infected patients, infection suspected patients, and infected patients. Inflammatory markers such as white blood cell count (WBC), C-reactive protein (CRP) and CD64 were measured before operation and one week after surgery. Using the receiver-operating characteristic (ROC) curve and Akaike's Information Criterion (AIC), the cutoff value of CD64 and CRP was calculated leading to a determination of which inflammatory marker is best accurate for detecting postoperative infection. RESULTS We found that postoperative CD64 and CRP levels presented a statistically significant difference between infected patients and non-infected patients (p < 0.05). Furthermore, comparison of the ROC curve and AIC value between postoperative CD64 and CRP levels exhibited that CD64 was more accurate infectious marker than CRP. CONCLUSION CD64 is a useful marker for detecting postoperative infection after orthopaedic surgery in dialysis patients.
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Affiliation(s)
- Toru Doi
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Tokuhide Doi
- Hakucho, Geriatric Health Care Facility for the Elderly, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization, Kanagawa, Japan
| | - Akiko Komiya
- Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization, Kanagawa, Japan
| | - Zaika Tei
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Gaku Niitsuma
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junichi Kunogi
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Meta-analysis of diagnostic accuracy of neutrophil CD64 for neonatal sepsis. Ital J Pediatr 2016; 42:57. [PMID: 27268050 PMCID: PMC4897921 DOI: 10.1186/s13052-016-0268-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/30/2016] [Indexed: 01/21/2023] Open
Abstract
Background The aim of this study was to systematically evaluate the diagnostic performance of nCD64 for neonatal sepsis. Methods Computer retrieval was conducted for the databases of PubMed, Embase, and Springer databases up to March 18, 2015 to select the relevant studies on nCD64 and neonatal sepsis. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and 95 % confidence intervals (CI) for diagnostic efficiency of nCD64 were pooled. In addition, the summary receiver operating characteristic (SROC) curve was also conducted based on the sensitivity and specificity. Results Seventeen studies including 3478 participants were included in this meta-analysis. The overall pooled sensitivity, specificity, PLR, NLR and DOR were 0.77 (95 % CI: 0.74–0.79), 0.74 (95 % CI: 0.72–0.75), 3.58 (95 % CI: 2.85–4.49), 0.29 (95 % CI: 0.22–0.37) and 15.18 (95 % CI: 9.75–23.62), respectively. In addition, the area under the SROC curve (AUC) was 0.8666, and no threshold effect was found based on the Spearman correlation analysis (P = 0.616). Besides, subgroup analysis showed higher sensitivity, specificity and AUC in term infants and proven infection group than those in preterm infants and clinical infection group, respectively. Conclusions The n CD64 expression alone is not a satisfactory marker for diagnosing neonatal sepsis with relatively low sensitivity, specificity, PLR and NLR, in spite of relatively high SROC area. Therefore, the n CD64 expression used in diagnosis of neonatal sepsis should be treated with caution.
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Delanghe JR, Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clin Chim Acta 2015; 451:46-64. [DOI: 10.1016/j.cca.2015.01.031] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/24/2015] [Accepted: 01/24/2015] [Indexed: 01/22/2023]
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Barbosa GGDA, Farias MG, Ludwig HC, Stensmann I, Fernandes MV, Michalowski MB, Daudt LE. Could CD64 expression be used as a predictor of positive culture results in children with febrile neutropenia? Rev Bras Hematol Hemoter 2015; 37:395-9. [PMID: 26670402 PMCID: PMC4678915 DOI: 10.1016/j.bjhh.2015.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/02/2015] [Accepted: 08/21/2015] [Indexed: 12/05/2022] Open
Abstract
Background Early recognition of infectious processes in neutropenic patients is hampered by the fact that these processes may have dissimilar and non-specific clinical presentations. CD64 is a neutrophil surface marker that is not expressed in non-sensitized neutrophils. When the neutrophil is exposed to tumor necrosis factor-alpha it is activated and is measured via the CD64 index. Methods This paper evaluated the relationship between the index value of CD64 on the first day of febrile neutropenia and a positive blood culture. The correlations with white blood count, C-reactive protein and erythrocyte sedimentation rate were also evaluated. This case–control, prospective, diagnostic study included 64 episodes of neutropenia. Case group (n = 14) comprised positive blood cultures, and the control group (n = 50), negative blood cultures. Results The median rates of CD64 were 2.1 (σ ± 3.9) in the case group and 1.76 (σ ± 5.02) in the control group. There was no correlation between the value of the CD64 index and blood cultures. The CD64 index was also not correlated with C-reactive protein positivity. Furthermore, the CD64 index was not able to predict blood culture positivity. The sensitivity was 64.3%, the specificity was 42%, the positive predictive value was 23.7% and the negative predictive value was 80%. For C-reactive protein, the sensitivity, specificity, positive predictive value, and negative predictive value were 71.4%, 32%, 22.7%, and 80%, respectively. Conclusion The CD64 index is not suitable for predicting the positivity of blood cultures in this specific population of patients with febrile neutropenia.
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Affiliation(s)
| | | | | | - Isabel Stensmann
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, RS, Brazil
| | | | - Mariana Bohns Michalowski
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA), Porto Alegre, RS, Brazil; Hospital da Criança de Santo Antonio, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Kipfmueller F, Schneider J, Prusseit J, Dimitriou I, Zur B, Franz AR, Bartmann P, Mueller A. Role of Neutrophil CD64 Index as a Screening Marker for Late-Onset Sepsis in Very Low Birth Weight Infants. PLoS One 2015; 10:e0124634. [PMID: 25894336 PMCID: PMC4404048 DOI: 10.1371/journal.pone.0124634] [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: 12/19/2014] [Accepted: 03/17/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction The role of CD64 in late onset sepsis (LOS) in preterm infants has been described in several studies. Aim of this study was to investigate whether CD64 expression is increased in the days before clinical manifestation of LOS. Methods Patients with birth weight below 1,500g were eligible for study participation. During routine blood sampling CD64 index was determined between day of life 4 and 28. Patients were allocated to one of four groups: (1) blood-culture positive sepsis, (2) clinical sepsis, (3) symptoms of infection without biochemical evidence of infection, or (4) patients without suspected infection. Kinetics of CD64 expression were compared during a period before and after the day of infection in the respective groups. Results 50 infants were prospectively enrolled and allocated to each group as follows: group (1) n = 7; group (2) n = 10; group (3) n = 8; and group (4) n = 25. CD64 index was elevated in 57% of patients in group (1) at least two days before infection. In contrast only 20% in the clinical sepsis group and 0% in group (3) had an elevated CD64 index in the days before infection. 10 of the 25 patients in the control group (4) presented increased CD64 index values during the study period. Conclusions The CD64 index might be a promising marker to detect LOS before infants demonstrate signs or symptoms of infection. However, larger prospective studies are needed to define optimal cut-off values and to investigate the role of non-infectious inflammation in this patient group.
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Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Jessica Schneider
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Julia Prusseit
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Ioanna Dimitriou
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Axel R. Franz
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- Current affiliation: Department of Neonatology, University Children’s Hospital Tuebingen, Tuebingen, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
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Monocyte CD64 does not enhance neutrophil CD64 as a diagnostic marker in neonatal sepsis. Pediatr Infect Dis J 2014; 33:1100-1. [PMID: 25361194 DOI: 10.1097/inf.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Du J, Li L, Dou Y, Li P, Chen R, Liu H. Diagnostic utility of neutrophil CD64 as a marker for early-onset sepsis in preterm neonates. PLoS One 2014; 9:e102647. [PMID: 25033045 PMCID: PMC4102545 DOI: 10.1371/journal.pone.0102647] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/22/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Neutrophil CD64 has been proposed as an early marker of sepsis. This study aims to evaluate the diagnostic utility of neutrophil CD64 for identification of early-onset sepsis in preterm neonates. Methods The prospective study was conducted in a neonatal intensive care unit between November 2010 and June 2011. Preterm neonates in whom infection was suspected when they were <12 hours of age were enrolled. Complete blood count with differential, blood culture, neutrophil CD11b and CD64 measurement were performed. Receiver operating characteristic curve analysis was performed to evaluate the performance of neutrophil CD64 as biomarker of sepsis. Results A total of 158 preterm neonates was enrolled, 88 of whom were suspected infection. The suspected sepsis group was of lesser gestational age (P<0.001) and lower birth weight (P<0.001), compared with controls. The hematologic profiles of the suspected sepsis group were characterized by higher white blood cell count, neutrophil counts and C-reactive protein. The suspected sepsis neonates had significantly higher neutrophil CD64 expression compared with controls. Neutrophil CD64 had an area value under the curve of 0.869 with an optimal cutoff values of 1010 phycoerythrin molecules bound/cell and it had a high sensitivity (81.82%) and negative predictive value (77.4%). The level of neutrophil CD64 was independent of antibiotic therapy within 24 hours after the onset of sepsis in preterm neonates. Conclusions Neutrophil CD64 is a highly sensitive marker for suspected early-onset sepsis in preterm neonates. Our study suggests that neutrophil CD64 may be incorporated as a valuable marker to diagnose infection.
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Affiliation(s)
- Jikun Du
- Department of Clinical Laboratory, Shenzhen Shajing Hospital Affiliated of Guangzhou Medical University, Shenzhen, China
| | - Li Li
- Department of Pharmacology, Guangdong Medical College, Dongguan, China
| | - Yuhong Dou
- Department of Clinical Laboratory, Shenzhen Shajing Hospital Affiliated of Guangzhou Medical University, Shenzhen, China
| | - Peipei Li
- Department of Clinical Laboratory, Shenzhen Shajing Hospital Affiliated of Guangzhou Medical University, Shenzhen, China
| | - Rui Chen
- Shenzhen Baoan Maternal and Child Health Hospital, Shenzhen, China
- * E-mail: (RC); (HL)
| | - Helu Liu
- Department of Clinical Laboratory, Shenzhen Shajing Hospital Affiliated of Guangzhou Medical University, Shenzhen, China
- * E-mail: (RC); (HL)
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Motta M, Zini A, Regazzoli A, Garzoli E, Chirico G, Caimi L, Calarco M. Diagnostic accuracy and prognostic value of the CD64 index in very low birth weight neonates as a marker of early-onset sepsis. ACTA ACUST UNITED AC 2014; 46:433-9. [DOI: 10.3109/00365548.2014.896028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Zhang H, Ling XL, Wu YY, Lü MH, Guo H, Zhang PB, Zhao XY, Yang SM. CD64 expression is increased in patients with severe acute pancreatitis: clinical significance. Gut Liver 2014; 8:445-51. [PMID: 25071912 PMCID: PMC4113046 DOI: 10.5009/gnl.2014.8.4.445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Upregulated CD64 expression on neutrophils is the most useful marker for acute bacterial infections and systemic inflammation. However, it is unknown whether CD64 is involved in the pathogenesis of acute pancreatitis (AP). This study was designed to determine whether CD64 is implicated in severe acute pancreatitis (SAP), and thus, is a suitable marker for SAP. METHODS SAP was induced in rats with an intraperitoneal injection of L-arginine. CD64 expression in the rat pancreas was determined by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry. Additionally, the CD64 mRNA expression in peripheral blood leukocytes from 21 patients with mild acute pancreatitis (MAP) and 10 patients with SAP was investigated at the time of admission and during remission by qRT-PCR. RESULTS CD64 mRNA and protein expression in the pancreas was significantly higher in rats with SAP, compared to the controls. The CD64 expression was higher in the patients with SAP than in the patients with MAP. During remission, CD64 mRNA decreased in both the MAP and SAP patients. The area under the curve of CD64 expression for the detection of SAP was superior to both the Ranson and the Acute Physiology and Chronic Health Evaluation II scores. CONCLUSIONS The CD64 level was significantly increased in correlation with the disease severity in SAP and may act as a useful marker for predicting the development of SAP.
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Affiliation(s)
- Hao Zhang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ; Department of Gastroenterology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xian-Long Ling
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yu-Yun Wu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Mu-Han Lü
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Hong Guo
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Peng-Bin Zhang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiao-Yan Zhao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Ming Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ; Biomedical Analysis Center, Third Military Medical University, Chongqing, China ; Chongqing Key Laboratory for Diseases Proteomics, Southwest Hospital, Third Military Medical University, Chongqing, China
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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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Markic J, Jeroncic A, Polancec D, Bosnjak N, Markotic A, Mestrovic J, Culic VC. CD15s is a potential biomarker of serious bacterial infection in infants admitted to hospital. Eur J Pediatr 2013; 172:1363-9. [PMID: 23728509 DOI: 10.1007/s00431-013-2047-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
Early recognition of serious bacterial infection (SBI) in children is essential for better treatment outcome. Flow cytometry analysis of neutrophil surface molecules has been more frequently utilized as a tool for diagnosis of infection. The infants (n = 105) under 6 months of age presenting to the pediatric emergency department with fever without apparent source who were hospitalized with suspicion of having SBI were enrolled in this prospective study. Sixty-nine infants were included into the training pool and were classified into bacterial or viral infection group. Validation pool consisted of 36 infants. The values of white blood cells counts, absolute neutrophil count (ANC), C-reactive protein (CRP), procalcitonin (PCT), neutrophil CD11b, CD15s and CD64 expression, and the percentage (%CD15s+) and absolute count (AC-CD15s+) of CD15s+ neutrophils were determined. In infants with SBI, %CD15s+ was 10.5 times more likely to be higher than the cut-off value. ANC, CRP, PCT, CD64, and AC-CD15s+ were also found as useful biomarkers for differentiation between bacterial and viral infection. The best fit multivariate logistic regression model included CRP, PCT, and %CD15s+ as strong predictors of SBI. The model's sensitivity (87 %) and specificity (83 %) indicated high model's accuracy. After validation on independent dataset, model's accuracy maintained high: 86 % sensitivity and 93 % specificity, confirming its reliability and supporting CRP, PCT, and %CD15s+ as real predictors. The findings of this study support assumption made in the literature on significance of CD15s in inflammation processes. Also, this study demonstrated for the first time that CD15s is potentially valuable biomarker of SBI in infants.
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Affiliation(s)
- Josko Markic
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia,
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Lam HS, Cheung HM, Poon TCW, Wong RPO, Leung KT, Li K, Ng PC. Neutrophil CD64 for daily surveillance of systemic infection and necrotizing enterocolitis in preterm infants. Clin Chem 2013; 59:1753-60. [PMID: 24046202 DOI: 10.1373/clinchem.2013.209536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early detection and treatment of infected preterm infants could decrease morbidity and mortality. Neutrophil CD64 has been shown to be an excellent early diagnostic biomarker of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC). We aimed to study whether using CD64 as a daily surveillance biomarker could predict LOS/NEC before clinical manifestation. METHODS We collected 0.1 mL whole blood from very low birth weight (VLBW) infants from day 7 postnatal age until routine daily blood tests were no longer required. Four categories of responses were defined: proven sepsis, clinical sepsis, nonsepsis/non-NEC, and asymptomatic CD64 activation. RESULTS A total of 146 infants were consecutively recruited and 155 episodes of sepsis evaluation were performed. The biomarker screening utility, sensitivity, specificity, positive predictive value, and negative predictive value for surveillance of LOS/NEC using a cutoff of 5655 antibody-PE (phycoerythrin) molecules bound/cell were 89%, 98%, 41%, and 99.8%, respectively. LOS/NEC was detected a mean of 1.5 days before clinical presentation. However, 63 episodes of CD64 activation occurred in asymptomatic infants who would not otherwise have required sepsis evaluations. CONCLUSIONS As a surveillance biomarker, neutrophil CD64 detected LOS/NEC 1.5 days before clinical presentation, but at the expense of performing 41% additional sepsis evaluations. This was mainly attributed to an unexpected group of asymptomatic infants with CD64 activation, who recovered spontaneously and did not require antimicrobial treatment. The latter group has not been previously recognized in VLBW infants and could represent subclinical infection secondary to transient bacterial translocation or mild viral infection.
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Affiliation(s)
- Hugh Simon Lam
- Department of Paediatrics, The Chinese University of Hong Kong, China
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Jia LQ, Shen YC, Hu QJ, Wan C, Wang T, Chen L, Wen FQ. Diagnostic accuracy of neutrophil CD64 expression in neonatal infection: A meta-analysis. J Int Med Res 2013; 41:934-43. [PMID: 23867450 DOI: 10.1177/0300060513489799] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective *Liu-Qun Jia and Yong-Chun Shen contributed equally to this work and are joint first authors. The aim of the present study was to establish the predictive values of neutrophil CD64 expression in diagnosing neonatal infection. Methods A comprehensive search of the PubMed and Embase® literature databases identified outcome data from published studies estimating the diagnostic accuracy of neutrophil CD64 expression for neonatal infection. Summary estimates for sensitivity, specificity, diagnostic odds ratios (DOR) and the area under the summary receiver operating characteristic curve (AUC) were calculated using a bivariate random-effects approach. Results Twelve studies including 1915 neonates were analysed. Summary estimates (95% confidence intervals) for CD64 expression in the diagnosis of neonatal infection were: sensitivity, 0.78 (0.75, 0.81); specificity, 0.81 (0.78, 0.83); DOR, 21.27 (11.71, 38.65); positive-likelihood ratio, 4.53 (3.22, 6.36); negative-likelihood ratio, 0.23 (0.14, 0.37); AUC, 0.89. Conclusions Neutrophil CD64 expression can be used as an additional test in the diagnosis of neonatal infection. Results of a CD64 assay should not be used alone to diagnose such infections, but should be interpreted in combination with other test results and clinical findings.
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Affiliation(s)
- Liu-Qun Jia
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Yong-Chun Shen
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Qian-Jing Hu
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Chun Wan
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Tao Wang
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Lei Chen
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Fu-Qiang Wen
- Division of Medicine, West China Hospital of Sichuan University, Sichuan, Chengdu, China
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Flow cytometry in the detection of neonatal sepsis. Int J Pediatr 2013; 2013:763191. [PMID: 23431318 PMCID: PMC3574650 DOI: 10.1155/2013/763191] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 12/17/2022] Open
Abstract
Neonatal sepsis remains a burden problem by showing minimal initial symptoms of subtle character, nonspecific manifestation, and diagnostic pitfalls. The clinical course can be fulminant and fatal if treatment is not commenced promptly. It is therefore crucial to establish early diagnosis and initiate adequate therapy. Besides clinical symptoms, the most reliable laboratory markers in establishing diagnosis is currently the combined measurement of CRP and a cytokine (IL-6 and IL-8). Due to their different kinetics, a diagnostic gap might occur and thus withholding antimicrobial therapy in clinical suspicion of infection is not acceptable. We therefore need parameters which unerringly differentiate between infants in need for antimicrobial therapy and those who are not. Flow cytometry promises to be a useful tool in this field, allowing the determination of different cellular, dissolved, and functional pathophysiological components of sepsis. Despite technical and methodical advances in flow cytometry, its use in clinical routine is still limited. Advantages and disadvantages of promising new parameters in diagnosis of sepsis performed by flow cytometry, particularly CD64, HLA-DR, and apoptosis, are reviewed here. The necessity of tests to be used as an “ideal” parameter is presented.
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