失代偿期慢性肝病患儿感染的生物标志物：中性粒细胞CD64还是降钙素原？

Biomarker for infection in children with decompensated chronic liver disease: Neutrophilic CD64 or procalcitonin?

作者信息

Vinayagamoorthy Vignesh, Srivastava Anshu, Anuja Anamika Kumari, Agarwal Vikas, Marak Rungmei, Sarma Moinak Sen, Poddar Ujjal, Yachha Surender Kumar

机构信息

Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.

出版信息

Clin Res Hepatol Gastroenterol. 2024 Oct;48(8):102432. doi: 10.1016/j.clinre.2024.102432. Epub 2024 Jul 28.

DOI:10.1016/j.clinre.2024.102432

PMID:39074717

Abstract

OBJECTIVE

Biomarkers with high accuracy for identification of infection in decompensated chronic liver disease (DCLD) are urgently needed. We compared the accuracy of neutrophilic cluster of differentiation 64 (nCD64) with procalcitonin for diagnosis of bacterial infection in children with DCLD.

METHODS

Consecutive children admitted with DCLD were enrolled prospectively. nCD64 was assessed by flow cytometry and expressed in percentage. nCD64, procalcitonin and hemogram were measured at admission and 7-14 days after treatment in those with infection. Complete work-up for infection was done. Presence, site and severity of infection was classified as per guidelines.

RESULTS

107 children [64 boys, age 97(18-168) months] were enrolled. 78(72.9%) had infection, 26(24%) had severe sepsis and 60(56%) had systemic inflammatory response syndrome. The commonest site of infection was ascitic fluid (n=37), followed by pneumonia (n=24), urinary tract (n=15), bacteraemia (n=10), cholangitis (n=8) and cellulitis (n=3). nCD64 (cut-off-51%, AUC-0.82) had a higher sensitivity (79.5%) and specificity (82.8%) than procalcitonin (cut-off ≥0.58ng/mL, AUC-0.74, sensitivity-76.9% and specificity-62.1%) for diagnosis of infection. nCD64 and procalcitonin correlated with infection severity, being highest in children with severe sepsis [88(71-97) %and 1.98(0.83-10.36) ng/mL], than in infection alone [72(45-84) % and 1.09(0.45-2.07) ng/mL], and no-infection [36(20.2-48) % and 0.42(0.19-1.08) ng/mL]. There was no difference in diagnostic utility of procalcitonin or nCD64 with different sites of infection. Elevation of all 3 parameters (nCD64, PCT and total leukocyte count) was uncommon but highly specific for presence of infection.

CONCLUSION

nCD64 identifies infection better than procalcitonin and correlates well with infection severity in children with DCLD.

摘要

目的

迫切需要用于识别失代偿性慢性肝病（DCLD）感染的高精度生物标志物。我们比较了中性粒细胞分化簇64（nCD64）与降钙素原在诊断DCLD患儿细菌感染方面的准确性。

方法

前瞻性纳入连续收治的DCLD患儿。通过流式细胞术评估nCD64，并以百分比表示。对有感染的患儿在入院时及治疗7 - 14天后测量nCD64、降钙素原和血常规。对感染进行全面检查。根据指南对感染的存在、部位和严重程度进行分类。

结果

共纳入107例患儿[64例男孩，年龄97（18 - 168）个月]。78例（72.9%）有感染，26例（24%）有严重脓毒症，60例（56%）有全身炎症反应综合征。最常见的感染部位是腹水（n = 37），其次是肺炎（n = 24）、泌尿道（n = 15）、菌血症（n = 10）、胆管炎（n = 8）和蜂窝织炎（n = 3）。在诊断感染方面，nCD64（临界值 - 51%，AUC - 0.82）比降钙素原（临界值≥0.58ng/mL，AUC - 0.74，敏感性 - 76.9%，特异性 - 62.1%）具有更高的敏感性（79.5%）和特异性（82.8%）。nCD64和降钙素原与感染严重程度相关，在严重脓毒症患儿中最高[88（71 - 97）%和1.98（0.83 - 10.36）ng/mL]，其次是单纯感染患儿[72（45 - 84）%和1.09（0.45 - 2.07）ng/mL]，无感染患儿[36（20.2 - 48）%和0.42（0.19 - 1.08）ng/mL]。降钙素原或nCD64在不同感染部位的诊断效用无差异。所有3项参数（nCD64、PCT和白细胞总数）升高并不常见，但对感染的存在具有高度特异性。