Xiong Shu-Dao, Pu Lian-Fang, Wang Hui-Ping, Hu Lin-Hui, Ding Yang-Yang, Li Man-Man, Yang Dong-Dong, Zhang Cui, Xie Jing-Xin, Zhai Zhi-Min
Clin Chem Lab Med. 2017 Jan 1;55(1):82-90. doi: 10.1515/cclm-2016-0118.
In the hematology department, the availability of biomarkers for early detection of infection is difficult to obtain. The present study aimed to compare the diagnostic values of neutrophil CD64 Index, procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) and to determine whether the combined analysis of these biomarkers offer stronger predictive power in the diagnosis for the infection of febrile patients.
Neutrophil CD64 Index, PCT, IL-6 and CRP levels were determined in 356 febrile patients in the hematology ward from May 2013 to May 2015. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, receiver operating characteristic (ROC) areas under the curve (AUC), and logistic regression analysis were determined to evaluate the diagnostic values of these biomarkers.
The levels of the four biomarkers were higher in the infection patients (p<0.001), and the PCT and IL-6 were higher in the patients with positive microbial blood culture (p<0.01). The neutrophil CD64 Index, PCT, IL-6, CRP had AUCs of 0.95, 0.83, 0.75 and 0.73, respectively. The best cut-off value of the neutrophil CD64 Index to detect infections was 5.06, with high specificity (87.5%) and sensitivity (88.4%). Furthermore, neutrophil CD64 Index, PCT and IL-6 offered the best combination of diagnosis with sensitivity of 93.9% and an AUC of 0.95. In addition, the neutrophil CD64 Index may have a special value to assist the physician to diagnose infection in the neutropenic patients with fever.
The neutrophil CD64 Index is useful for early identification of infections in febrile patients in the hematology department. The combined analysis of the CD64 Index, PCT and IL-6 could further improve its sensitivity.
在血液科，很难获得用于早期检测感染的生物标志物。本研究旨在比较中性粒细胞CD64指数、降钙素原（PCT）、白细胞介素-6（IL-6）和C反应蛋白（CRP）的诊断价值，并确定这些生物标志物的联合分析在发热患者感染诊断中是否具有更强的预测能力。
对2013年5月至2015年5月血液科病房的356例发热患者测定中性粒细胞CD64指数、PCT、IL-6和CRP水平。通过确定敏感性、特异性、阳性和阴性似然比、阳性和阴性预测值、受试者工作特征（ROC）曲线下面积（AUC）以及进行逻辑回归分析来评估这些生物标志物的诊断价值。
感染患者的四种生物标志物水平较高（p<0.001），微生物血培养阳性的患者中PCT和IL-6更高（p<0.01）。中性粒细胞CD64指数、PCT、IL-6、CRP的AUC分别为0.95、0.83、0.75和0.73。检测感染的中性粒细胞CD64指数最佳截断值为5.06，具有高特异性（87.5%）和敏感性（88.4%）。此外，中性粒细胞CD64指数、PCT和IL-6联合诊断效果最佳，敏感性为93.9%，AUC为0.95。此外，中性粒细胞CD64指数在协助医生诊断发热的中性粒细胞减少患者感染方面可能具有特殊价值。
中性粒细胞CD64指数有助于血液科发热患者感染的早期识别。CD64指数、PCT和IL-6的联合分析可进一步提高其敏感性。
