Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Hematology, PGIMER, Chandigarh, India.
J Trop Pediatr. 2021 Jan 29;67(1). doi: 10.1093/tropej/fmab016.
To compare the diagnostic accuracy of white blood cell-surface biomarkers (CD64, CD11b and HLA-DR), C-reactive protein (CRP) and hematological parameters to diagnose definite sepsis among pre-term neonates presenting with suspected late-onset neonatal sepsis (LONS).
This was a prospective, single-gate, diagnostic study in a Level III neonatal unit. Fifty-three neonates (gestation, <34 weeks) with LONS (onset, >72 age), were enrolled. Cell-surface biomarkers, CRP and haematological parameters were assayed at 0 and 48 h after onset. The reference standard was definite sepsis, defined as a positive blood culture with a non-contaminant organism. The index tests (cell-surface biomarkers, CRP and haematological parameters) were compared between subjects with or without 'definite sepsis'. The area under the receiver operator characteristics curves (AUC) generated for each index test at 0 and 48 h was compared.
Level III neonatal unit in a tertiary care institute.
Of 53 enrolled pre-term infants, 24 had definite sepsis. Among all the index tests evaluated, CRP at 48 h had the highest AUC [0.82 (95% confidence interval, 0.69, 0.92)]. The expression of CD11b and HLA-DR was significantly reduced among the septic neonates. Among the cell-surface biomarkers, the maximum AUC was recorded for HLA-DR at 48 [0.68 (95% CI, 0.54, 0.81)]. Comparisons between index tests were not statistically significant.
C-reactive protein is superior to other sepsis screen biomarkers and white blood cell-surface biomarkers in diagnosing culture-positive LONS among pre-term infants. CD64, CD11b and HLA DR as diagnostic tests in this group have limited discriminatory value.
The diagnosis of neonatal blood stream infections is a challenge. In response to bacterial blood stream infections, white blood cells are known to produce an excess of certain types of specialized proteins on their surface, including CD64, CD11b and HLA-DR. In this study we evaluated the concentration of these cell-surface proteins for diagnosing blood stream infections in pre-mature newborn babies, whose onset of infection was beyond 72 h of life. We compared these tests against standard tests that are currently in clinical use, such as C-reactive protein and blood white cell counts. All tests were performed at the time of initially suspecting the infection and 48 h later. The gold standard against which all these tests were evaluated was blood culture, in which the offending bacteria are grown in specialized laboratory media. Of 53 pre-mature babies with suspected infection, 24 had blood culture-proven infection. Among all tests, C-reactive protein at 48 h had the best ability to distinguish definite infection from no infection. The expression of CD11b and HLA-DR was significantly reduced among infected neonates. We conclude that C-reactive protein is superior to white blood cell-surface proteins and white cell count in diagnosing definite late-onset infections among pre-term infants.
比较白细胞表面标志物（CD64、CD11b 和 HLA-DR）、C 反应蛋白（CRP）和血液学参数在诊断疑似晚发型新生儿败血症（LONS）的早产儿中明确败血症的诊断准确性。
这是一项在三级新生儿病房进行的前瞻性单门诊断研究。共纳入 53 例（<34 周妊娠）有 LONS（发病>72 小时）的早产儿。在发病后 0 和 48 小时检测白细胞表面标志物、CRP 和血液学参数。参考标准为明确败血症，定义为阳性血培养伴非污染菌。将无或有“明确败血症”的受试者的指数试验（白细胞表面标志物、CRP 和血液学参数）进行比较。比较每个指数试验在 0 和 48 小时时的受试者工作特征曲线下面积（AUC）。
三级护理机构的新生儿病房。
在纳入的 53 例早产儿中，24 例有明确败血症。在评估的所有指数试验中，48 小时 CRP 的 AUC 最高[0.82（95%置信区间，0.69，0.92)]。败血症患儿的 CD11b 和 HLA-DR 表达明显降低。在白细胞表面标志物中，HLA-DR 在 48 小时时的 AUC 最大[0.68（95%CI，0.54，0.81)]。各指数试验之间的比较无统计学意义。
CRP 优于其他败血症筛查标志物和白细胞表面标志物，可诊断早产儿中培养阳性的 LONS。CD64、CD11b 和 HLA-DR 作为该组的诊断试验，其鉴别价值有限。
新生儿血流感染的诊断具有挑战性。针对细菌血流感染，已知白细胞会在其表面产生过量的某些类型的特殊蛋白，包括 CD64、CD11b 和 HLA-DR。在这项研究中，我们评估了这些细胞表面蛋白在诊断出生后 72 小时以上的早产儿血流感染中的浓度。我们将这些检测与目前临床使用的标准检测（如 C 反应蛋白和白细胞计数）进行了比较。所有检测均在最初怀疑感染时和 48 小时后进行。所有这些检测的金标准是血培养，在专门的实验室培养基中培养致病细菌。在 53 例疑似感染的早产儿中，24 例血培养证实感染。在所有检测中，48 小时 CRP 具有最佳能力区分明确感染和无感染。感染新生儿的 CD11b 和 HLA-DR 表达明显降低。我们得出结论，CRP 在诊断早产儿明确的晚发型感染方面优于白细胞表面蛋白和白细胞计数。
