Hashem Heba E, Abdel Halim Rania M, El Masry Sherin A, Mokhtar Amira M, Abdelaal Noureldin M
Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Pediatric and Neonatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Int J Microbiol. 2020 Nov 1;2020:8814892. doi: 10.1155/2020/8814892. eCollection 2020.
Neonatal septicemia is a critical medical situation; current conventional laboratory methods still have many limitations and diagnostic obstacles. For this purpose, last decades have witnessed a challenge between the battery of sepsis biomarkers including many leukocyte surface antigens, not only for early diagnostic purposes but also for better follow-up and good management of sepsis patients.
To evaluate the diagnostic, prognostic, and monitoring performance of both neutrophil CD64 (nCD64) and presepsin as sepsis biomarkers compared to each other and to the conventional laboratory sepsis parameters aiming to decide which is the best fitting for routine daily use in neonatal intensive care units (NICUs).
235 neonates were enrolled from three Egyptian neonatal ICUs, during the period from November 2015 till March 2018; they were classified into two main groups: the control group ( = 102) and the sepsis group ( = 133). Laboratory sepsis evaluation included highly sensitive CRP (hs-CRP), CBC, in addition to nCD64 (flow cytometry technique), and presepsin measurement (CLEIA technique combined with Magtration® technology); the diagnosis was confirmed thereafter by positive blood culture results (BacT/Alert system). Sixty-two of the enrolled sepsis neonates were subjected to follow-up assessment; they were reclassified according to their clinical improvement at the second time assessment into (group 1: sepsis group without improvement) ( = 20) and (group 2: improved sepsis group) ( = 42).
Significant increase in nCD64 and presepsin values was found in sepsis groups compared to the controls. At cutoff 41.6%, nCD64% could discriminate the presence of septicemia with sensitivity 94.7%, specificity 93.6 %, and AUC 0.925, while presepsin at cutoff 686 pg/ml achieves sensitivity 82.7%, specificity 95.5%, and AUC 0.887, respectively. Significant increase in nCD64 ( < 0.001) and hs-CRP (=0.018) values was observed in severe sepsis/septic shock patients compared to nonsevere sepsis patients. Delta change percentage (dC%) between initial and follow-up evaluations for both improved and nonimproved sepsis patients was dC value -5.904 for nCD64% followed by dC value -4.494 for presepsin.
nCD64 and presepsin are valuable early diagnostic and monitoring sepsis biomarkers; the highest sensitivity could be achieved by a univariant sepsis marker in this study was recorded by the nCD64% biomarker, while the highest specificity was documented by presepsin. Combined measurement of both achieves the highest diagnostic performance in sepsis neonates. Either of CD64 or presepsin combined with hs-CRP associated with better performance than any of them alone. nCD64 carries an additional promising role in reflecting sepsis prognosis.
新生儿败血症是一种危急的医疗状况；当前传统实验室方法仍存在诸多局限性和诊断障碍。为此，在过去几十年中，包括许多白细胞表面抗原在内的一系列败血症生物标志物面临挑战，这不仅是为了早期诊断，也是为了更好地随访和管理败血症患者。
评估中性粒细胞CD64（nCD64）和可溶性髓系细胞触发受体-1（ presepsin）作为败血症生物标志物的诊断、预后及监测性能，并将它们相互比较，同时与传统实验室败血症参数进行比较，以确定哪一种最适合新生儿重症监护病房（NICU）的日常常规使用。
2015年11月至2018年3月期间，从埃及的三个新生儿重症监护病房招募了235名新生儿；他们被分为两个主要组：对照组（n = 102）和败血症组（n = 133）。实验室败血症评估包括高敏C反应蛋白（hs-CRP）、全血细胞计数（CBC），此外还有nCD64（流式细胞术）和可溶性髓系细胞触发受体-1检测（化学发光免疫分析技术结合磁珠分离技术）；此后通过血培养阳性结果（BacT/Alert系统）确诊。62名入选的败血症新生儿接受了随访评估；根据第二次评估时的临床改善情况，他们被重新分类为（第1组：败血症未改善组）（n = 20）和（第2组：败血症改善组）（n = 42）。
与对照组相比，败血症组的nCD64和可溶性髓系细胞触发受体-1值显著升高。在临界值为41.6%时，nCD64%可鉴别败血症的存在，敏感性为94.7%，特异性为93.6%，曲线下面积（AUC）为0.925，而可溶性髓系细胞触发受体-1在临界值为686 pg/ml时，敏感性为82.7%，特异性为95.5%，AUC为0.887。与非重症败血症患者相比，重症败血症/感染性休克患者的nCD64（P < 0.001）和hs-CRP（P = 0.018）值显著升高。改善和未改善的败血症患者初始评估与随访评估之间的变化百分比（dC%），nCD64%的dC值为-5.904，其次可溶性髓系细胞触发受体-1的dC值为-4.494。
nCD64和可溶性髓系细胞触发受体-1是有价值的早期诊断和监测败血症生物标志物；本研究中，单变量败血症标志物中nCD64%记录的敏感性最高，而可溶性髓系细胞触发受体-1记录的特异性最高。两者联合检测在败血症新生儿中具有最高的诊断性能。CD64或可溶性髓系细胞触发受体-1与hs-CRP联合检测的性能优于它们单独检测。nCD64在反映败血症预后方面还有额外的重要作用。
