Sat, Jul 12, 2025
1- VARDHMAN MAHAVIR MEDICAL COLLEGE, NEW DELHI
2- VARDHMAN MAHAVIR MEDICAL COLLEGE, NEW DELHI ,anjalisharmapath@gmail.com
3- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
2- VARDHMAN MAHAVIR MEDICAL COLLEGE, NEW DELHI ,
3- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
Abstract: (335 Views)
Background & objectives: Sepsis is one of the most common cause of mortality among patients who are critically ill and in Intensive Care Units(ICU). Bacterial infection or sepsis leads to an increase in Neutrophilic CD64(nCD64) expression on activated polymorphonuclear leukocytes(PMNs). Early diagnosing of sepsis is very important in order to start timely and specific treatment. The availability of a rapid laboratory test with high specificity for sepsis in adult patients could aid in therapeutic decision making and reduce unnecessary antibiotic use.
Methods: Sepsis patients diagnosed as per sepsis-3 definition were included in this study. 2 ml blood sample was collected in EDTA & plain vial each for evaluation of nCD64, Procalcitonin(PCT) & high sensitivity C-reactive protein(hS-CRP). The samples were run on Flow cytometer, Nephelometer and Chemiluminescence for nCD64, hS-CRP and PCT respectively.
Result: The Positive Predictive Value(PPV) of nCD64 for prediction of sepsis was 92.68% and the Negative Predictive value(NPV) was 94.87%. Receiver operating curve(ROC) was plotted for indicating the diagnostic accuracy of nCD64(≥1.8), hS-CRP(≥3 mg/L) and PCT(≥0.4 ng/mL). Area under the curve(AUC) for nCD64 was highest[0.938(95%CI=0.876-0.999)] followed by hS-CRP[0.888(95%CI=0.807-0.968)] and PCT [0.850(95%CI =0.759-0.941)].
Conclusion: These findings are suggestive of the possibility that nCD64 determination was a useful tool for diagnosing infection in patients with septic syndrome, with a performance superior to that of hS-CRP and PCT.
Methods: Sepsis patients diagnosed as per sepsis-3 definition were included in this study. 2 ml blood sample was collected in EDTA & plain vial each for evaluation of nCD64, Procalcitonin(PCT) & high sensitivity C-reactive protein(hS-CRP). The samples were run on Flow cytometer, Nephelometer and Chemiluminescence for nCD64, hS-CRP and PCT respectively.
Result: The Positive Predictive Value(PPV) of nCD64 for prediction of sepsis was 92.68% and the Negative Predictive value(NPV) was 94.87%. Receiver operating curve(ROC) was plotted for indicating the diagnostic accuracy of nCD64(≥1.8), hS-CRP(≥3 mg/L) and PCT(≥0.4 ng/mL). Area under the curve(AUC) for nCD64 was highest[0.938(95%CI=0.876-0.999)] followed by hS-CRP[0.888(95%CI=0.807-0.968)] and PCT [0.850(95%CI =0.759-0.941)].
Conclusion: These findings are suggestive of the possibility that nCD64 determination was a useful tool for diagnosing infection in patients with septic syndrome, with a performance superior to that of hS-CRP and PCT.
References
1. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019:7:2050312119835043. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Remick DG. Pathophysiology of sepsis. Am J Pathol. 2007;170(5):1435-44. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Jones AE, Puskarich MA. Sepsis-induced tissue hypoperfusion. Crit Care Nurs Clin North Am. 2011;23(1):115-25. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 ;34(6):1589-96. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Peters RPH, van Agtmael MA, Danner SA, Savelkoul PHM, Vandenbroucke-Grauls CM. New developments in the diagnosis of bloodstream infections. Lancet Infect Dis. 2004;4(12):751-60. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. van Engelen TSR, Wiersinga WJ, Scicluna BP, van der Poll T. Biomarkers in Sepsis. Crit Care Clin. 2018;34(1):139-52. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Barth E, Fischer G, Schneider EM, Wollmeyer J, Georgieff M, Weiss M. Differences in the expression of CD64 and mCD14 on polymorphonuclear cells and on monocytes in patients with septic shock. Cytokine. 2001;14(5):299-302. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. [View at Publisher] [DOI:10.1001/jama.2016.0287] [PMID] [Google Scholar]
9. Barth E, Fischer G, Schneider EM, Wollmeyer J, Georgieff M, Weiss M. Differences in the expression of CD64 and mCD14 on polymorphonuclear cells and on monocytes in patients with septic shock. Cytokine. 2001;14(5):299-302. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Thompson KJ, Finfer SR, Woodward M, Leong RNF, Liu B. Sex differences in sepsis hospitalisations and outcomes in older women and men: A prospective cohort study. J Infect. 2022;84(6):770-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Kilinc Toker A, Kose S, Turken M. Comparison of SOFA Score, SIRS, qSOFA, and qSOFA + L Criteria in the Diagnosis and Prognosis of Sepsis. Eurasian J Med. 2021;53(1):40-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Liu C, Suo S, Luo L, Chen X, Ling C, Cao S. SOFA Score in relation to Sepsis: Clinical Implications in Diagnosis, Treatment, and Prognostic Assessment. Comput Math Methods Med. 2022;2022:7870434. . [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Wang HE, Shapiro NI, Safford MM, Griffin R, Judd S, Rodgers JB,et al. Warnock DG, Cushman M, Howard G. High-sensitivity C-reactive protein and risk of sepsis. PLoS One. 2013;8(7):e69232. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Lin CT, Lu JJ, Chen YC, Kok VC, Horng JT. Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department. PeerJ. 2017;5:e4094. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Zhang Y, La M, Sun J, Chen M, Liu D, Liu X, et al. Diagnostic Value and Prognostic Significance of Procalcitonin Combined with C-Reactive Protein in Patients with Bacterial Bloodstream Infection. Comput Math Methods Med. 2022;2022:6989229. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-17. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Toh H, Harada S, Kakudou T, Era F, Tokushige C, Yoshimura H, et al. [Usefulness of Procalcitonin Measurement for the Detection of Sepsis]. Rinsho Byori. 2014;62(10):931-6. . [PMID] [Google Scholar]
18. Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Cardelli P, Ferraironi M, Amodeo R, Tabacco F, De Blasi RA, Nicoletti M, et al. Evaluation of neutrophil CD64 expression and procalcitonin as useful markers in early diagnosis of sepsis. Int J Immunopathol Pharmacol. 2008;21(1):43-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Li S, Huang X, Chen Z, Zhong H, Peng Q, Deng Y, et al. Neutrophil CD64 expression as a biomarker in the early diagnosis of bacterial infection: a meta-analysis. Int J Infect Dis. 2013;17(1):e12-23. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. 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(5):313-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Gros A, Roussel M, Sauvadet E, Gacouin A, Marqué S, Chimot L, et al. The sensitivity of neutrophil CD64 expression as a biomarker of bacterial infection is low in critically ill patients. Intensive Care Med. 2012;38(3):445-52. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Livaditi O, Kotanidou A, Psarra A, Dimopoulou I, Sotiropoulou C, Augustatou K, et al. Neutrophil CD64 expression and serum IL-8: sensitive early markers of severity and outcome in sepsis. Cytokine 2006;36(5-6):283-90. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Patnaik R, Azim A, Agarwal V. Neutrophil CD64 a Diagnostic and Prognostic Marker of Sepsis in Adult Critically Ill Patients: A Brief Review. Indian J Crit Care Med. 2020;24(12):1242-1250. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Velissaris D, Zareifopoulos N, Lagadinou M, Platanaki C, Tsiotsios K, Stavridis EL, et al. Procalcitonin and sepsis in the Emergency Department: an update. Eur Rev Med Pharmacol Sci. 2021;25(1):466-79. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Zhang H, Wang X, Zhang Q, Xia Y, Liu D. Comparison of procalcitonin and high-sensitivity C-reactive protein for the diagnosis of sepsis and septic shock in the oldest old patients. BMC Geriatr. 2017;17(1):173. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Yin WP, Li JB, Zheng XF, An L, Shao H, Li CS. Effect of neutrophil CD64 for diagnosing sepsis in emergency department. World J Emerg Med. 2020;11(2):79-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Hsu KH, Chan MC, Wang JM, Lin LY, Wu CL. Comparison of Fcγ receptor expression on neutrophils with procalcitonin for the diagnosis of sepsis in critically ill patients. Respirology. 2011;16(1):152-60. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. 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(1):5. [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Enamad
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.