Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2127-2137
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2127
Diagnostic performance of Neutrophil CD64 index, procalcitonin, and C-reactive protein for early sepsis in hematological patients
Yu-Xi Shang, Zhi Zheng, Min Wang, Hui-Xia Guo, Yi-Juan Chen, Yue Wu, Xing Li, Qian Li, Jian-Ying Cui, Xiao-Xiao Ren, Li-Ru Wang
Yu-Xi Shang, Min Wang, Hui-Xia Guo, Yi-Juan Chen, Yue Wu, Xing Li, Qian Li, Jian-Ying Cui, Xiao-Xiao Ren, Li-Ru Wang, Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
Zhi Zheng, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Shang YX and Zheng Z contributed equally to this work, carried out the studies and participated in collecting the data; Shang YX and Zheng Z drafted the manuscript; Wang M, Guo HX, Wu Y, Li X and Chen YJ performed the statistical analysis and participated in its design; Li Q, Cui JY and Ren XX participated in acquisition, analysis, or interpretation of the data; Wang LR revised the manuscript; all authors read and approved the final manuscript.
Supported by Xicheng District Outstanding Talent Project (2018-2019, Shang YX), and Beijing Xicheng District Health Commission Young Science and Technology Talent (Science and Technology New Star) Training Project, No. xwkx2020-24.
Institutional review board statement: This study was approved by the Ethics Committee of Fuxing Hospital, Capital Medical University, No. 2014FXHEC-KY020.
Clinical trial registration statement: The trial was registered in March 2020 on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn/index.aspx). The registration number is ChiCTR2100044348.
Informed consent statement: The Ethics Committee waived the need for informed consent due to the use of anonymized data for analysis.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Ru Wang, MD, PhD, Chief Doctor, Director, Doctor, Department of Hematology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical University, No. 20 Fuxing Street, Xicheng District, Beijing 100038, China. liruwang@ccmu.edu.cn
Received: July 20, 2021
Peer-review started: July 20, 2021
First decision: October 16, 2021
Revised: October 16, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: March 6, 2022
Processing time: 224 Days and 12.7 Hours
Abstract
BACKGROUND

Patients with hematological diseases are immunosuppressed due to various factors, including the disease itself and treatments, such as chemotherapy and immunotherapy, and are susceptible to infection. Infections in these patients often progress rapidly to sepsis, which is life-threatening.

AIM

To evaluate the diagnostic efficacy of the neutrophil CD64 (nCD64) index, compared to procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP), for the identification of early sepsis in patients with hematological diseases.

METHODS

This was a prospective analysis of patients with hematological diseases treated at the Fuxing Hospital affiliated with Capital Medical University, between March 2014 and December 2018. The nCD64 index was quantified by flow cytometry and the Leuko64 assay software. The factors which may affect the nCD64 index levels were compared between patients with different infection statuses (local infection, sepsis, and no infection), and the control group and the nCD64 index levels were compared among the groups. The diagnostic efficacy of the nCD64 index, PCT, and hs-CRP for early sepsis was evaluated among patients with hematological diseases.

RESULTS

A total of 207 patients with hematological diseases (non-infected group, n = 50; locally infected group, n = 67; sepsis group, n = 90) and 26 healthy volunteers were analyzed. According to the absolute neutrophil count (ANC), patients with hematological diseases without infection were divided into the normal ANC, ANC reduced, and ANC deficiency groups. There was no statistically significant difference in the nCD64 index between these three groups (P = 0.586). However, there was a difference in the nCD64 index among the non-infected (0.74 ± 0.26), locally infected (1.47 ± 1.10), and sepsis (2.62 ± 1.60) groups (P < 0.001). The area under the diagnosis curve of the nCD64 index, evaluated as the difference between the sepsis and locally infected group, 0.777, which was higher than for PCT (0.735) and hs-CRP (0.670). The positive and negative likelihood ratios were also better for the nCD64 index than either PCT and hs-CRP.

CONCLUSION

Our results indicate the usefulness of the nCD64 index as an inflammatory marker of early sepsis in hematological patients.

Keywords: CD64 index; Hematological diseases; Sepsis; Procalcitonin; C-reactive protein

Core Tip: Early sepsis in hematological patients is difficult to diagnosis, often progresses rapidly, and has a high mortality rate. The neutrophil CD64 (nCD64) index has high sensitivity and specificity as a diagnostic marker of early sepsis. We confirm the usefulness of this index in hematological patients, with the diagnostic efficacy of the nCD64 index for early sepsis in this clinical population being significantly better than high-sensitivity C-reactive protein and superior to procalcitonin. The index can be helpful in evaluating the severity of infection in patients with hematological diseases.