Zakaria Marwa, Karam Nehad, Hassan Tamer, Zidan Nahla, Abdelsalam Asmaa, Ramadan Raghdaa A, Rashad Marwa L M, Abdelaziz Eman, Ramadan Ahmed, Ali Ahmed A
Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ital J Pediatr. 2025 May 14;51(1):139. doi: 10.1186/s13052-025-01979-9.
Febrile neutropenia (FN) is a common treatment-related complication in pediatric cancer patients with substantial morbidities and mortalities. Previous studies reported that neutrophil CD64 (n CD64) had higher diagnostic accuracy for infection with high sensitivity and specificity in neonates, pediatrics and adult patients. We aimed to evaluate the usefulness of neutrophil CD64 expression as an early diagnostic marker of sepsis in children with cancer during episodes of FN.
a case control study was conducted on 100 children (50 patients with hematological malignancies and febrile neutropenia, 25 patients with hematological malignancies without febrile neutropenia and 25 apparently healthy children as a control group). Routine laboratory investigations including blood culture were done in patients with cancer according to our local standards. Procalcitonin level and Neutrophil CD64 expression by flowcytometry were measured for all study participants.
n CD64 expression was significantly higher in patients with cancer and FN compared to other groups (p > 0.001). At a cutoff value of ≥ 17.82%, serum n CD64 had 94% sensitivity and 72% specificity. n CD64 expression level was negatively correlated to absolute neutrophil count (ANC) during episode of FN (r= (-0.359, p = 0.01). A positive correlation was found between nCD64 expression and both of CRP and procalcitonin. Blood culture was positive in 54% in patients with cancer and FN. The most common isolated organism was Kllibselia pneumonia. Among patients with cancer and FN, n CD64 expression level was significantly higher in patients with positive blood culture compared to those with negative cultures.
Neutrophil CD64 expression seems to be a reliable marker in early detection of sepsis during episodes of febrile neutropenia in children with hematological malignancies.
发热性中性粒细胞减少症（FN）是儿科癌症患者常见的与治疗相关的并发症，具有较高的发病率和死亡率。既往研究报道，中性粒细胞CD64（n CD64）在新生儿、儿童和成人患者中对感染具有较高的诊断准确性，敏感性和特异性均较高。我们旨在评估中性粒细胞CD64表达作为癌症患儿FN发作期间脓毒症早期诊断标志物的有效性。
对100名儿童进行了病例对照研究（50例血液系统恶性肿瘤合并发热性中性粒细胞减少症患者，25例无发热性中性粒细胞减少症的血液系统恶性肿瘤患者，以及25名健康儿童作为对照组）。根据我们当地的标准，对癌症患者进行了包括血培养在内的常规实验室检查。对所有研究参与者测量降钙素原水平和通过流式细胞术检测中性粒细胞CD64表达。
与其他组相比，癌症合并FN患者的n CD64表达显著更高（p < 0.001）。血清n CD64在截断值≥17.82%时，敏感性为94%，特异性为72%。在FN发作期间，n CD64表达水平与绝对中性粒细胞计数（ANC）呈负相关（r = (-0.359, p = 0.01）。nCD64表达与C反应蛋白（CRP）和降钙素原均呈正相关。癌症合并FN患者血培养阳性率为54%。最常见的分离菌是肺炎克雷伯菌。在癌症合并FN患者中，血培养阳性患者的n CD64表达水平显著高于血培养阴性患者。
中性粒细胞CD64表达似乎是血液系统恶性肿瘤患儿发热性中性粒细胞减少症发作期间脓毒症早期检测的可靠标志物。
