Background sepsis in neonates hospitalized in the neonatal intensive care unit is a global problem and is a significant contributor to morbidity and mortality. Neutrophil cd64 as a diagnostic marker for neonatal sepsis. Neutrophil cd64 has a high negative predictive value for exclusion of neonatal sepsis m b dhlamini, m s suchard, t m wiggill, o o fadahun, d e ballot department of molecular medicine and haematology, national health laboratory service and faculty of health sciences, university of the witwatersrand, johannesburg. Sepsis is a global health problem as it is an important cause of morbidity and mortality among newborn infants. Cd64 is one of the immunoglobulin receptors expressed on monocytes and eosinophils.
Introduction neutrophil cd64 has been proposed as an early marker of sepsis. Sepsis is the most common cause of mortality in critically ill patients worldwide. Cd64 expression alone is not a satisfactory marker for diagnosing neonatal sepsis with relatively low sensitivity, specificity, plr and nlr, in spite of relatively high sroc area. Therefore, this metaanalysis was conducted to clarify the importance of cd64 combined with crp in the diagnosis of neonatal sepsis. Sepsis is a potentially lifethreatening complication of infection and diagnosis depends on rapid assessment of leukocyte count and cd64 expression. Early diagnosis sepsis and timely treatment are vital to improving outcomes and lightening the financial burden for patients. Methods the prospective study was conducted in a neonatal intensive care unit between november 2010 and june 2011. Surface neutrophil cd64 expression has been shown to be upregulated in cases of bacterial infection. Neutrophil cd64 is an improved indicator of infection or. Effect of neutrophil cd64 for diagnosing sepsis in. This makes neutrophil cd64 a potential biomarker for infection and sepsis.
Early diagnosis of neonatal sepsis is challenging because clinical picture is not specific and hard to be discriminated from that of noninfectious causes. The pubmed and the cochrane library combined search term used was cd64 and neonatal sepsis or neonatal infectious or sepsis, and the embase combined search term was cd64 and sepsis. This study evaluated the diagnostic and prognostic potential of the ratio of neutrophilic cd64 ncd64 and monocytic hladr mhladr median fluorescence index in monitoring of neonatal sepsis. Methods according to discharge diagnosis, 37 neonates with bacterial infection were divided into sepsis n 15 and ordinary infection non sepsis groups n 22. Eighty neonates with neonatal sepsis 21 culture positive, 59. Precise estimates of neonatal sepsis burden vary by setting. In addition, the diagnostic accuracy of cd64 expression for neonatal infection at different timepoints after the onset of infection, and specifically in neonatal sepsis, were explored. Diagnostic value of cd64 in early detection of neonatal sepsis. Cd64 index provides simple and predictive testing for.
Clinical policy neonatal sepsis management page 2 of 6 once the culture and sensitivity results are known and antibiotic therapy is established, a medically stable infant should be transitioned to a lower level of care for treatment. Late onset sepsis is usually presents after 72 hours of age4. A prospective study enrolled newborns with documented sepsis n 25, clinical sepsis n 25, and control newborns n 25. Pdf role of cd64 in the diagnosis of neonatal sepsis. Blood from 100 neonates suspected of sepsis and 29 healthy controls was collected on clinical suspicion of sepsis, and the expression of ncd64, mhladr was evaluated by flow cytometry. The results show that ncd64 is a reliable marker for diagnosing neonatal sepsis. Creactive protein, neutrophil cd64, complete blood counts, and blood cultures were. Earlyonset neonatal infections of viral or fungal etiology may also occur at sepsis 8, 9. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The sensitivity and negative predictive value of the neutrophil cd64 assay was consistently. Italian journal of pediatrics metaanalysis of diagnostic accuracy of neutrophil cd64 for neonatal sepsis jing shi 0 jun tang 0 dapeng chen 0 equal contributors department of pediatrics, west china second university hospital, sichuan university, no 20 section 3 south renming road, chengdu, sichuan province 610041, peoples republic of china s background.
The clinical course can be fulminant and fatal if treatment is not commenced promptly. Cd64 combined with creactive protein crp could improve the sensitivity and specificity of neonatal sepsis diagnosis, but the results were still controversial. Neonatal sepsis is one of the important causes of neonatal mortality. Despite the improvement in management of newborn infant, the mortality caused by neonatal sepsis remains high 10 % 1.
Blood creactive protein crp level was measured routinely. Neutrophil and monocyte cd64 and cd163 expression in. The correlation of fcgamma receptor i cd64 expression and. Despite the improvement in management of newborn infant, the mortality caused by neonatal sepsis remains high 10 %. Diagnosis of sepsis was recorded and appropriateness of empirical antibiotic treatment was established post hoc. Preterm neonates in whom infection was suspected when they were cd64 does not enhance neutrophil cd64 as a diagnostic marker in neonatal sepsis. We assessed neutrophil cd64 as a diagnostic marker for neonatal sepsis.
This study aimed to identify an early diagnostic marker for neonatal sepsis. Evaluation of neutrophil cd64 as a marker in the diagnosis of. The prospective study was conducted in a neonatal intensive. It was possible that neonatal sepsis might occur in the absence. Value of combined determination of neutrophil cd64 and. Despite with huge costs, it is difficult to treat sepsis. One hundred fiftyone adult patients diagnosed with sepsis and 20 agematched healthy controls were enrolled in the study. For earlyonset sepsis, the cd64 index with a cutpoint value of 2. Pdf neutrophil cd64 as a diagnostic marker of sepsis in. Diagnostic value of neutrophil cd64 combined with crp for.
Introduction neonatal sepsis is neonatal response to various infections which can occur in early or late onset. Diagnosis of neonatal sepsis is one of the most difficult tasks in clinical practice, as the disease progress more rapidly. Dec 12, 2015 thus, there is an urgent need of a biomarker that can identify sepsis in an early stage so that timely and appropriate use of antibiotics can be initiated. Objective our goal in this prospective study was to measure the neutrophil cd64 in blood as an adjunct to our previously. The rapid diagnosis and management of bacterial infection are heavily dependent upon clinical assessment. However, our findings indicated that cd64 remained a sensitive marker for identification of early and lateonset neonatal sepsis. Neutrophil surface cd64, the highaffinity fc receptor, is quantitatively upregulated during infection and sepsis. Evaluation of various diagnostic markers for early detection. Evaluation of neutrophil cd64 expression, white blood cell count, platelet count, it ratio and creactive protein crp in early diagnosis of neonatal sepsis was aim of this study. Bigelow 2006 neutrophil cd64 is an improved indicator of infection or sepsis in emergency department patients.
It is therefore crucial to establish early diagnosis and initiate adequate therapy. Evaluation of neutrophil cd64 as a marker in the diagnosis. Evaluation of various diagnostic markers for early. Metaanalysis of diagnostic accuracy of neutrophil cd64. Neonatal sepsis ns is a clinical syndrome occurring in infants. In this study, the existing haematology scoring system hss and the cell population data cpd volume, conductivity, and scatter of neutrophils and monocytes and the novel flow cytometric. To the authors knowledge, the present metaanalysis is the first to estimate the diagnostic accuracy of neutrophil cd64 expression for neonatal infection. Indeed there is ample literature on the diagnostic utility of neutrophil cd64 in a variety of diseases. Approaches to monitoring of sepsis have traditionally relied upon the proinflammatory component of the sepsis response. The aim of this study is to investigate the diagnostic and prognostic value of neutrophil cd64 ncd64 as a novel biomarker in sepsis patients. The databases were searched from their inception through june 2015. Diagnostic utility of neutrophil cd64 as a marker for early.
Role of neutrophil cd64 as an emerging biomarker in the. Blood culture may take up to 2 days for results and may be suspect. Evaluation of various diagnostic markers for early detection of neonatal sepsis jerusha samuela jacob1, febe renjitha suman d 1, sai shalini cn, binu ninan2, suresh varadarajan3 and jesu magdalene1 1department of pathology, sri ramachandra medical college and research institute, sri ramachandra university, chennai, india 2department of neonatology, sri ramachandra. Effective biomarkers for diagnosis of neonatal sepsis.
Sepsis is a significant health problem in the united states with an estimated 750,000 new cases annually. Monocyte cd64 does not enhance neutrophil cd64 as a diagnostic marker in neonatal sepsis. Neutrophil cd64 as a diagnostic marker of sepsis in. For lateonset sepsis, the respective values were 3. A pointofcare microfluidic biochip for quantification of. Metaanalysis of diagnostic accuracy of neutrophil cd64 for. In fact, during the 3year analysis period only three infants were identified with positive blood cultures that had a normal cd64 index. Neonatal sepsis is the cause of substantial morbidity and mortality.
It is difficult to diagnose neonatal sepsis during early stage. Pdf monocyte cd64 does not enhance neutrophil cd64 as a. Neutrophil cd64 as a diagnostic marker of sepsis in neonates. Nnf ns 3 neonatal sepsis commonest cause of neonatal deaths prematurity 15% others % asphyxia 20% sepsis 52% source. Recently, a standardized kit for the cd64 index was used in neonatal intensive care. Differing estimates of disease burden have been reported from highincome countries compared with reports from lowincome and middleincome countries. It is difficult to diagnose neonatal sepsis during early stage because of the nonspecific and variable clinical symptoms. Neonatal sepsis clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life. Neutrophil cd64 is a sensitive diagnostic marker for early. The gold standard tool for diagnosis of neonatal sepsis is blood culture. Neutrophil cd64 expression was measured by flow cytometry at admission and daily until discharge or death. The role of ncd64 in the diagnosis of neonatal sepsis in. Serial determinations of neutrophil cd64 expression for the. Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection bsi such as meningitis, pneumonia, pyelonephritis, or gastroenteritis in the setting of fever.
Neutrophil cd64 has a high negative predictive value for. This study aims to evaluate the diagnostic utility of neutrophil cd64 for identification of earlyonset sepsis in preterm neonates. Sepsis in the newborn sepsis is the commonest cause of neonatal mortality. The n cd64 expression alone is not a satisfactory marker for diagnosing neonatal sepsis with relatively low sensitivity, specificity, plr and nlr, in spite of relatively high sroc area. The correlation of fcgamma receptor i cd64 expression. Objective to investigate the value of combined determination of neutrophil cd64 and procalcitonin pct in the early diagnosis of neonatal bacterial infection. The clinical manifestations range from subclinical infection to severe. Neonatal sepsis is a diagnosis made in infants less than 28 days of life and consists of a clinical syndrome that may include systemic signs of infection, circulatory shock, and multisystem organ failure. An ideal biomarker for neonatal sepsis needs to have a high degree of accuracy in recognizing the presence or absence of definite infection at an early stage, with results being available with a short tat, for it to be useful to guide the. Neutrophil cd64 has been proposed as an early marker of sepsis. Original article ratio of neutrophilic cd64 and monocytic hladr. Therefore, the n cd64 expression used in diagnosis of neonatal sepsis. A novel parameter in diagnosis and prognostication of neonatal sepsis richeek pradhan,1 paresh jain,2 anshuman paria,3 anindya saha,3 jagdish sahoo,3 anway sen,4 suchandra mukherjee,3 tapas som,3 avijit hazra,1 noel warner,5 arun k singh,3 and mitali chatterjee1 1department of pharmacology. The purpose of this study was to develop a new method to evaluate neutrophil cd64 expression for diagnosis of neonatal sepsis.
Jan 29, 2019 neonatal sepsis ns is a clinical syndrome occurring in infants. Diagnostic utility of neutrophil cd64 as a marker for. Neonatal sepsis is the main cause of morbidity and mortality in developing countries. A study was considered eligible for inclusion in the.
Utility of presepsin, soluble triggering receptor expressed. Neutrophil cd64 as a diagnostic marker in neonatal sepsis. Neonatal sepsis remains a burden problem by showing minimal initial symptoms of subtle character, nonspecific manifestation, and diagnostic pitfalls. Therefore, the n cd64 expression used in diagnosis of neonatal sepsis should be treated with caution. Differing estimates of disease burden have been reported from highincome countries compared with reports. Neutrophil cd64, neonatal sepsis, diagnosis, metaanalysis background neonatal sepsis is one of the important causes of neonatal mortality. Cd64 expression is low on resting neutrophils, and it is rapidly deregulated after activation by bacteria. Evaluation of neutrophil cd64 as a marker in the diagnosis of neonatal sepsis european academic research vol. To evaluate the expression of cd64 and cd163 on neutrophils and monocytes in sirs withwithout sepsis and to compare the diagnostic accuracy of cd64 and cd163 molecules expression determined as 1 mean fluorescence intensities mfi of cd64 and cd163. Cluster of differentiation 64 cd64 is a type of integral membrane glycoprotein known as fc receptor that binds monomeric igg with high affinity.
As the positive predictive value of the test was low in confirming infection, pmn cd64 should be used as a screening rather than confirmatory test. Ri cd64 expression in early onset neonatal sepsis figure 1 shows the mean expression of fc. Mar 23, 2020 early diagnosis of neonatal sepsis is challenging because clinical picture is not specific and hard to be discriminated from that of noninfectious causes. Diagnostic accuracy of neutrophil cd64 expression in neonatal.
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