Serial determinations of neutrophil CD64 expression for the diagnosis and monitoring of sepsis in critically ill patients

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Aikaterini DimoulaJean-Louis Vincent

Abstract

Early identification of sepsis is important to be able to initiate timely therapy and optimize survival. Neutrophil CD64 (nCD64) expression has been proposed as a potential marker of sepsis. In this prospective observational study, adult patients admitted to our 34-bed medico-surgical department of intensive care over a 3.5-month period were included. Neutrophil CD64 expression was measured by flow cytometry at admission and daily until discharge or death. Blood C-reactive protein (CRP) level was measured routinely. Diagnosis of sepsis was recorded and appropriateness of empirical antibiotic treatment was established post hoc. Of the 548 patients included, 468 had flow cytometry measurements within 24 hours after admission, of whom 103 had sepsis. Septic patients had higher admission nCD64 expression than did nonseptic patients (P < .001). A cutoff admission nCD64 expression of 230 median fluorescence intensity (MFI) identified sepsis with a sensitivity of 89% (81%-94%) and specificity of 87% (83%-90%). When combining CRP and nCD64 expression, an abnormal result for both was associated with a 92% probability of sepsis, whereas sepsis was ruled out with a probability of 99% if both were normal. Septic patients receiving inapprop...Continue Reading

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