Effect of neutrophil CD64 for diagnosing sepsis in emergency department

doi:10.5847/wjem.j.1920-8642.2020.02.003

Abstract

Abstract:

BACKGROUND: The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64 (nCD64) as a novel biomarker in sepsis patients.

METHODS: One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study. Patients with sepsis were further subdivided into a sepsis group and a septic shock group. nCD64 expression, serum procalcitonin (PCT) level, C-reactive protein (CRP) level, and white blood cell (WBC) count were obtained for each patient, and Sequential Organ Failure Assessment (SOFA) scores were calculated.

RESULTS: nCD64 expression was higher in the sepsis group with confirmed infection than in the control group. The receiver operating characteristic (ROC) curve of nCD64 was higher than those of SOFA score, PCT, CRP and WBC for diagnosing infection. The area under the curve (AUC) of nCD64 combined with SOFA score was the highest for all parameters. The AUC of nCD64 for predicting 28-day mortality in sepsis was significantly higher than those of PCT, CRP, and WBC, but slightly lower than that of SOFA score. The AUC of nCD64 or PCT combined with SOFA score was significantly higher than that of any single parameter for predicting 28-day mortality.

CONCLUSION: nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.

Key words: Neutrophil CD64, Sepsis, Sequential Organ Failure Assessment score, Procalcitonin, Prognosis, Biomarker

Wen-peng Yin, Jia-bao Li, Xiao-fang Zheng, Le An, Huan Shao, Chun-sheng Li. Effect of neutrophil CD64 for diagnosing sepsis in emergency department[J]. World Journal of Emergency Medicine, 2020, 11(2): 79-86.

Figures/Tables 9

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Variables	Control (n=20)	Sepsis (n=119)	Septic shock (n=32)	P value
Age, years	62.5±6.3	65.2±15.9	66.3±15.2	0.332^a
Male, n (%)	12 (60.0)	77 (64.7)	26 (81.3)	0.074^b
Mortality, n (%)	0	15 (12.6)	15 (46.9)	0.000
Infection site, n (%)
Respiratory	0	86 (72.3)	26 (81.3)	0.303
hepatobilinary	0	6 (5.0)	2 (6.3)	0.677
Urinary	0	11 (9.2)	2 (6.3)	0.736
Gastrointestinal	0	14 (11.8)	2 (6.3)	0.525
Cutaneous	0	2 (1.7)	0	1.000
Comorbidity, n (%)
COPD	0	36 (30.3)	15 (46.9)	0.078
Diabetes	0	28 (23.5)	19 (59.4)	0.000
CDVD	0	32 (26.9)	12 (37.5)	0.241
CBVD	0	26 (21.8)	8 (25.0)	0.705
CRD	0	15 (12.6)	6 (18.8)	0.393
HBD	0	13 (10.9)	3 (9.4)	1.000
Healthy	0	11 (9.2)	7 (21.9)	0.065
Positive culture, n
Klebsiella pneumoniae	0	4	3
Streptococcus pneumoniae	0	2	2
Staphylococcus aureus	0	3	3
Pseudomonas aeruginosa	0	2	3
Escherichia coli	0	1	4
Enterobactor cloacae	0	1	0
SOFA	0	3 (3, 4)	6 (3, 8)	<0.001
CD64 (MFI)	2.2 (2.0, 2.5)	4.1 (3.1, 6.6)	9 (6.4, 14.8)	<0.001
PCT (ng/mL)	0.04 (0.02, 0.06)	1.8 (0.4, 7.0)	17.1 (6.7, 45.0)	<0.001
CRP (mg/L)	4.6 (3.9, 6.2)	13.6 (12.6, 14.6)	14.6 (12.4, 15.7)	0.086
WBC (×10⁹/L)	5.7 (5.0, 6.7)	12.0 (9.1, 15.3)	12.9 (7.9, 19.1)	0.503

Variables	AUC (95% CI)	P value	Cut-off value	Sensitivity	Specificity	PPV	NPV
SOFA	0.701 (0.579-0.824)	0.001	5.5	0.571	0.829	0.431	0.895
CD64	0.879 (0.795-0.962)	<0.001	8	0.750	0.894	0.616	0.940
PCT	0.868 (0.798-0.937)	<0.001	4.85	0.929	0.699	0.412	0.977
CRP	0.609 (0.491-0.727)	0.071	14.69	0.464	0.772	0.316	0.864
WBC	0.525 (0.399-0.651)	0.681	15.14	0.429	0.748	0.279	0.852
CD64+SOFA	0.888 (0.814-0.962)	<0.001	0.195	0.821	0.829	0.521	0.953
PCT+SOFA	0.848 (0.752-0.945)	<0.001	0.164	0.821	0.813	0.499	0.952
CRP+SOFA	0.716 (0.596-0.835)	<0.001	0.227	0.571	0.829	0.431	0.895
WBC+SOFA	0.700 (0.578-0.822)	0.001	0.247	0.571	0.837	0.443	0.896

Variables	Survival (n=121)	Death (n=30)	P value
Age, years	64.3 (55.7, 79.2)	72.5 (62.0, 80.3)	0.052
Male, n (%)	84 (69.4)	19 (63.3)	0.521
Infection site, n (%)
Respiratory	88 (72.7)	24 (80.0)	0.415
hepatobilinary	6 (5.0)	2 (6.7)	0.659
Urinary	11 (9.1)	2 (6.7)	1.000
Gastrointestinal	14 (11.6)	2 (6.7)	0.740
Cutaneous	2 (1.7)	0	1.000
Comorbidity, n (%)
COPD	38 (31.4)	13 (43.3)	0.216
Diabetes	35 (28.9)	12 (40.0)	0.241
CDVD	36 (29.8)	8 (26.7)	0.739
CBVD	32 (26.4)	2 (6.7)	0.020
CRD	13 (10.7)	8 (26.7)	0.037
HBD	11 (9.1)	2 (6.7)	1.000
Healthy	13 (10.7)	5 (16.7)	0.357
Positive culture, n
Klebsiella pneumoniae	3	4
Streptococcus pneumoniae	3	1
Staphylococcus aureus	4	2
Pseudomonas aeruginosa	3	2
Escherichia coli	2	3
Enterobactor cloacae	1	0
SOFA	3 (3, 4)	7.5 (5.8, 9)	<0.001
CD64 (MFI)	4.1 (3.1, 6.6)	8.9 (2.9, 10.8)	<0.001
PCT (ng/mL)	1.8 (0.4, 8.8)	9.2 (3.1, 20.7)	0.001
CRP (mg/L)	13.6 (12.4, 14.7)	14.5 (13.1, 15.7)	0.038
WBC (×10⁹/L)	12.4 (9, 15.4)	11.1 (7.4, 20.3)	0.618

Variables	AUC (95% CI)	P value	Cut-off value	Sensitivity	Specificity	PPV	NPV
SOFA	0.889 (0.821-0.958)	0.000	5.500	0.767	0.884	0.621	0.939
CD64	0.850 (0.786-0.914)	0.000	5.450	0.933	0.653	0.400	0.975
PCT	0.700 (0.606-0.759)	0.001	6.470	0.700	0.686	0.356	0.902
CRP	0.622 (0.505-0.740)	0.038	14.050	0.633	0.612	0.288	0.871
WBC	0.529 (0.398-0.661)	0.618	21.645	0.233	0.950	0.536	0.833
CD64+SOFA	0.916 (0.857-0.976)	0.000	0.369	0.800	0.950	0.799	0.950
PCT+SOFA	0.882 (0.812-0.952)	0.000	0.288	0.767	0.901	0.658	0.940
CRP+SOFA	0.895 (0.829-0.961)	0.000	0.262	0.767	0.884	0.621	0.939
WBC+SOFA	0.890 (0.817-0.963)	0.000	0.218	0.800	0.868	0.600	0.946

Variables	β	Wald	P value	Adjusted OR	95% CI
SOFA	0.641	10.881	0.001	1.898	1.297-2.776
CD64	0.272	4.612	0.032	1.312	1.024-1.682
Constant	-6.301	27.898	0.000	0.002