Clin Chem Lab Med 2015; 53(4): e89–e91
Letter to the Editor Petra Roginaa, David Stubljara, Tatjana Lejko-Zupanc, Josko Osredkar and Miha Skvarc*
Expression of CD64 on neutrophils (CD64 index): diagnostic accuracy of CD64 index to predict sepsis in critically ill patients DOI 10.1515/cclm-2014-0814 Received August 13, 2014; accepted September 18, 2014; previously published online October 15, 2014
Keywords: CD64 index; C-reactive protein (CRP); intensive care unit; procalcitonin (PCT); sepsis. To the Editor, Sepsis is still a serious problem and diagnosis should be available as fast as possible [1]. The biomarkers of bacterial infection can be helpful to make the correct diagnosis [2]. Procalcitonin (PCT) is the marker that has been used the most. However, it is also increased in cases of systemic inflammatory response syndrome (SIRS) due to non-infectious disease conditions, such as severe congestive heart failure, or in acute pancreatitis and viral infection [3]. We designed an observational retrospective study aimed at evaluating the diagnostic accuracy and the prognostic value of neutrophil CD64 expression in critically ill patients with possible systemic bacterial infection hospitalized at two intensive care units in comparison to PCT, C-reactive protein (CRP), white cells blood count and percentage of neutrophils to predict possible severe systemic bacterial infection in an observational retrospective study. a Petra Rogina and David Stubljar contributed equally to the study. *Corresponding author: Miha Skvarc, Institute of Microbiology and Immunology, Faculty of Medicine, Zaloska 4, 1000 Ljubljana, Slovenia, Phone: +38615437470, E-mail: [email protected] Petra Rogina: General Hospital Novo mesto, Smihelska 1, Novo mesto, Slovenia David Stubljar: Institute of Microbiology and Immunology, Faculty of Medicine, Ljubljana, Slovenia Tatjana Lejko-Zupanc: Infectious Disease Department, University Medical Center, Ljubljana, Slovenia Josko Osredkar: Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
The study took place at University Clinical Center Ljubljana, Slovenia. We included 88 adult patients who self-reported to have fever ≥ 38 °C at least during the last 24 h and had at least two SIRS criteria set by Surviving Sepsis Campaign [1]. We excluded patients if they had taken antibiotics during the last 24 h. The Republic of Slovenia National Medical Ethics Committee approved the study. The following samples for culture were taken: urine, respiratory tract samples, samples from other sites when infection foci were unknown, blood filled in two pairs (4 bottles altogether) of blood cultures (aerobic and anaerobic) bottles (BacT/ALERT 3D, bioMerieux, France). We identified positive culture findings with VITEK® automated analyzer (bioMerieux). We included the following biomarkers of infection in the study: the white blood cell count (WBC), the CRP (Siemens Healthcare Diagnostics, Germany), PCT (Brahms, Germany) and expression of CD64 on neutrophils presented as CD64 index measured on flow cytometer (Trillium Diagnostics, LCC, USA). After the end of the treatment two physicians retrospectively evaluated the patient’s data. They assigned the final diagnosis based on clinical, laboratory and microbiological data. Bacterial infection was confirmed if antibiotic therapy helped and if WBC and CRP normalized. The statistical analysis was performed by using Statistical Package for the Social Sciences 19.0 (SPSS, Chicago, IL, USA). A non-parametric Kruskal-Wallis test and χ2-test were used for comparing quantitative variables between four groups of diagnoses (SIRS without infection, sepsis, severe sepsis, septic shock) and between two groups of patients (one group patients without infection and the other patients with infection). A p-value
Letter to the Editor Petra Roginaa, David Stubljara, Tatjana Lejko-Zupanc, Josko Osredkar and Miha Skvarc*
Expression of CD64 on neutrophils (CD64 index): diagnostic accuracy of CD64 index to predict sepsis in critically ill patients DOI 10.1515/cclm-2014-0814 Received August 13, 2014; accepted September 18, 2014; previously published online October 15, 2014
Keywords: CD64 index; C-reactive protein (CRP); intensive care unit; procalcitonin (PCT); sepsis. To the Editor, Sepsis is still a serious problem and diagnosis should be available as fast as possible [1]. The biomarkers of bacterial infection can be helpful to make the correct diagnosis [2]. Procalcitonin (PCT) is the marker that has been used the most. However, it is also increased in cases of systemic inflammatory response syndrome (SIRS) due to non-infectious disease conditions, such as severe congestive heart failure, or in acute pancreatitis and viral infection [3]. We designed an observational retrospective study aimed at evaluating the diagnostic accuracy and the prognostic value of neutrophil CD64 expression in critically ill patients with possible systemic bacterial infection hospitalized at two intensive care units in comparison to PCT, C-reactive protein (CRP), white cells blood count and percentage of neutrophils to predict possible severe systemic bacterial infection in an observational retrospective study. a Petra Rogina and David Stubljar contributed equally to the study. *Corresponding author: Miha Skvarc, Institute of Microbiology and Immunology, Faculty of Medicine, Zaloska 4, 1000 Ljubljana, Slovenia, Phone: +38615437470, E-mail: [email protected] Petra Rogina: General Hospital Novo mesto, Smihelska 1, Novo mesto, Slovenia David Stubljar: Institute of Microbiology and Immunology, Faculty of Medicine, Ljubljana, Slovenia Tatjana Lejko-Zupanc: Infectious Disease Department, University Medical Center, Ljubljana, Slovenia Josko Osredkar: Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
The study took place at University Clinical Center Ljubljana, Slovenia. We included 88 adult patients who self-reported to have fever ≥ 38 °C at least during the last 24 h and had at least two SIRS criteria set by Surviving Sepsis Campaign [1]. We excluded patients if they had taken antibiotics during the last 24 h. The Republic of Slovenia National Medical Ethics Committee approved the study. The following samples for culture were taken: urine, respiratory tract samples, samples from other sites when infection foci were unknown, blood filled in two pairs (4 bottles altogether) of blood cultures (aerobic and anaerobic) bottles (BacT/ALERT 3D, bioMerieux, France). We identified positive culture findings with VITEK® automated analyzer (bioMerieux). We included the following biomarkers of infection in the study: the white blood cell count (WBC), the CRP (Siemens Healthcare Diagnostics, Germany), PCT (Brahms, Germany) and expression of CD64 on neutrophils presented as CD64 index measured on flow cytometer (Trillium Diagnostics, LCC, USA). After the end of the treatment two physicians retrospectively evaluated the patient’s data. They assigned the final diagnosis based on clinical, laboratory and microbiological data. Bacterial infection was confirmed if antibiotic therapy helped and if WBC and CRP normalized. The statistical analysis was performed by using Statistical Package for the Social Sciences 19.0 (SPSS, Chicago, IL, USA). A non-parametric Kruskal-Wallis test and χ2-test were used for comparing quantitative variables between four groups of diagnoses (SIRS without infection, sepsis, severe sepsis, septic shock) and between two groups of patients (one group patients without infection and the other patients with infection). A p-value
