Diagnostic value of neutrophil CD64, procalcitonin, and interleukin-6 in sepsis: a meta-analysis

Abstract

Background The aim of the study was to conduct a meta-analysis to evaluate the accuracy of neutrophil CD64, procalcitonin (PCT), and interleukin-6 (IL-6) as markers for the diagnosis of sepsis in adult patients. Methods Various databases were searched to collect published studies on the diagnosis of sepsis in adult patients using neutrophil CD64, PCT, and IL-6 levels. Utilizing the Stata SE 15.0 software, forest plots and the area under the summary receiver operating characteristic curves were drawn. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC) were calculated. Results Fifty-four articles were included in the study. The pooled sensitivity, specificity, and AUC of neutrophil CD64 for the diagnosis of sepsis were 0.88 (95% confidence interval [CI], 0.81–0.92), 0.88 (95% CI, 0.83–0.91), and 0.94 (95% CI, 0.91–0.96), respectively. The pooled sensitivity, specificity, and AUC of PCT for the diagnosis of sepsis were 0.82 (95% CI, 0.78–0.85), 0.78 (95% CI, 0.74–0.82), and 0.87 (95% CI, 0.83–0.89), respectively. Subgroup analysis showed that the AUC for PCT diagnosis of intensive care unit (ICU) sepsis was 0.86 (95% CI, 0.83–0.89) and the AUC for PCT diagnosis of non-ICU sepsis was 0.82 (95% CI, 0.78–0.85). The pooled sensitivity, specificity, and AUC of IL-6 for the diagnosis of sepsis were 0.72 (95% CI, 0.65–0.78), 0.70 (95% CI, 0.62–0.76), and 0.77 (95% CI, 0.73–0.80), respectively. Conclusions Of the three biomarkers studied, neutrophil CD64 showed the highest diagnostic value for sepsis, followed by PCT, and IL-6. On the other hand, PCT showed a better diagnostic potential for the diagnosis of sepsis in patients with severe conditions compared with that in patients with non-severe conditions.

Machine learning identification of specific changes in myeloid cell phenotype during bloodstream infections

“…However, a wide variation in the performance of CD64 can be observed, depending on the study design. In 2021, Cong et al compiled 20 studies and found that the pooled sensitivity and specificity were 0.88 (95% CI 0.81–0.92) and 0.88 (95% CI 0.83–0.91), respectively 68 . Our results suggest that CD64 has > 80% specificity, but its sensitivity is modest (70%) in distinguishing infectious from noninfectious patients and even low (59%) in discriminating localized versus systemic infection.…”

Circulating lymphocyte subsets as promising biomarkers to identify septic patients at higher risk of unfavorable outcome

“…Furthermore, several clinical scores were evaluated for their ability to recognize patients at higher risk of death, but a recent systematic review and meta-analysis suggested that Early Warning Scores and qSOFA not always predict mortality accurately in patients with sepsis [ 29 , 30 ]. In addition, many studies in the literature tested the independent value of biochemical markers for their ability to predict sepsis, without conclusive results, leaving clinicians in the need of further aid [ 31 – 34 ]. The evaluation of specific subsets of peripheral immune cells may, indeed, improve current prediction models to timely recognize septic patients at higher risk of poor outcome, taking into account the immunological status at onset of sepsis [ 27 ].…”

The Interplay between Host Defense, Infection, and Clinical Status in Septic Patients: A Narrative Review

“…CD64 is an IgG-binding receptor expressed by neutrophils, monocytes, and macrophages in response to cytokines released during bacterial infection; given that its expression is upregulated in the early stages of activation of the innate immune response, it performs particularly well as a diagnostic marker of sepsis [ 122 ], although its use might be limited by flow cytometry, the method used for CD64 detection, requiring specialized laboratory equipment.…”