Valuable Role of Neutrophil CD64 and Highly Sensitive CRP Biomarkers for Diagnostic, Monitoring, and Prognostic Evaluations of Sepsis Patients in Neonatal ICUs

الملخص EN

Background.

Neonatal sepsis (NS) is a very critical medical situation associated with high morbidities and mortalities.

There is an utmost need for a new tool helping in early diagnosis and proper management of sepsis neonates.

Neutrophil CD64 (nCD64) shows a very promising value in this concerning issue.

Aim.

Evaluate the diagnostic, monitoring, and prognostic performances of nCD64 and highly sensitive CRP (hs-CRP) in NS as well as the possible best panel of biomarkers that can achieve the most desirable results.

Methods.

Patients were enrolled from three neonatal intensive care units (NICUs) (n=121 patients) and classified according to their initial sepsis evaluation into three groups: disease control group (n=30), proven sepsis group (n=17), and clinical sepsis group (n=74).

Laboratory evaluation included hs-CRP, complete blood count (CBC), and blood culture in addition to nCD64 (done by flow cytometry technique).

Besides the diagnostic evaluations, follow-up evaluations were done for 40 patients after five days from the first time; patients were reclassified according to their outcome into the improved sepsis neonates’ group (n=26) and sepsis neonates without improvement (n=14).

Results.

Significant increase in nCD64 and hs-CRP results were present in sepsis groups compared to the disease controls (P<0.001); nCD64 at 43% cutoff value could detect the presence of sepsis with 85.6% sensitivity and 93% specificity.

Additionally, delta change percentage (dC%) between improved sepsis neonates and sepsis neonates without improvement showed a significant difference in the levels of both nCD64 (P<0.001) and hs-CRP (P=0.001).

Conclusion.

Besides the promising diagnostic performance documented by nCD64 which is higher than the other laboratory sepsis biomarkers used routinely in NICUs, nCD64 has a valuable role in sepsis patients’ monitoring and prognostic evaluation.

hs-CRP was moderate in its diagnostic and monitoring results being less than that achieved by nCD64.

Combined measurement of nCD64% and hs-CRP gives better diagnostic and monitoring performance than that achieved by any of them alone.