Neutrophil Expression of Cd64 in Early Diagnosis of Early Onset Neonatal Sepsis.

Abstract

The diagnosis of sepsis remains one of the most difficult tasks for physicians and other medical staff. Blood cultures often remain negative in the presence of pneumonia, meningitis and even fulminant blood born septicemia. A rapid laboratory test with high specificity for neonatal sepsis would be a valuable tool in therapeutic decision making and avoiding the unnecessary use of antibiotics in patients with clinical signs and symptoms of sepsis but negative blood cultures. The rapid upregulation of CD64 expression on the polymorphnuclear neutrophils (PMNs) and the normal 6-hour half-life of the blood PMNs made the determination of the PMN CD64 expression a true indication of the current status of neonatal sepsis. In this study, we selected the CD64 to detect its value in the diagnosis of early-onset neonatal sepsis cases by using the flow cytometry. We aimed to evaluate its association with the different demographic, clinical and laboratory data. The current study was carried out on 100 patients; 40 diagnosed early onset neonatal sepsis (EONS) (culture + ve) neonates, 40 clinically suspected EONS (culture -ve) and 20 neonates (healthy or admitted for jaundice) as a control group. All patients were subjected to complete history taking, thorough clinical examination and laboratory investigations. We found that; CD 64 expression was only positive in both EONS groups but not in control group. CD64 expression was significantly higher in EONS (culture +ve) group than in suspected EONS (culture -ve). It has high sensitivity (80%) and intermediate +ve predictive value (53%), but low specificity (10%). We found that CD64 expression had no correlation to any of the clinical or laboratory findings except for the temperature and CRP. when we used the ROC curve to compare the area under the curve between the CD64 & CRP we found that the area under the curve (accuracy) for CD64 =0.855, while area under the curve (accuracy) for CRP =0.493. This implies the greater diagnostic power for CD64 than CRP for early detection of EONS.