Point-of-care neutrophil CD64 as a rule in diagnostic test for bacterial infections in the emergency department.
Bacterial infections
COVID-19
Inflammation
Point of care immunology
Viral infections
nCD64
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
14 03 2023
14 03 2023
Historique:
received:
31
05
2022
accepted:
28
02
2023
entrez:
14
3
2023
pubmed:
15
3
2023
medline:
16
3
2023
Statut:
epublish
Résumé
Bacterial infections are frequently seen in the emergency department (ED), but can be difficult to distinguish from viral infections and some non-infectious diseases. Common biomarkers such as c-reactive protein (CRP) and white blood cell (WBC) counts fail to aid in the differential diagnosis. Neutrophil CD64 (nCD64), an IgG receptor, is suggested to be more specific for bacterial infections. This study investigated if nCD64 can distinguish bacterial infections from other infectious and non-infectious diseases in the ED. All COVID-19 suspected patients who visited the ED and for which a definitive diagnosis was made, were included. Blood was analyzed using an automated flow cytometer within 2 h after presentation. Patients were divided into a bacterial, viral, and non-infectious disease group. We determined the diagnostic value of nCD64 and compared this to those of CRP and WBC counts. Of the 291 patients presented at the ED, 182 patients were included with a definitive diagnosis (bacterial infection n = 78; viral infection n = 64; non-infectious disease n = 40). ROC-curves were plotted, with AUCs of 0.71 [95%CI: 0.64-0.79], 0.77 [0.69-0.84] and 0.64 [0.55-0.73] for nCD64, WBC counts and CRP, respectively. In the bacterial group, nCD64 MFI was significantly higher compared to the other groups (p < 0.01). A cut-off of 9.4 AU MFI for nCD64 corresponded with a positive predictive value of 1.00 (sensitivity of 0.27, a specificity of 1.00, and an NPV of 0.64). Furthermore, a diagnostic algorithm was constructed which can serve as an example of what a future biomarker prediction model could look like. For patients in the ED presenting with a suspected infection, nCD64 measured with automatic flow cytometry, has a high specificity and positive predictive value for diagnosing a bacterial infection. However, a low nCD64 cannot rule out a bacterial infection. For future purposes, nCD64 should be combined with additional tests to form an algorithm that adequately diagnoses infectious diseases.
Identifiants
pubmed: 36915043
doi: 10.1186/s12873-023-00800-2
pii: 10.1186/s12873-023-00800-2
pmc: PMC10010956
doi:
Substances chimiques
Biomarkers
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28Investigateurs
Thomas M P Nijdam
(TMP)
Bas J J Bindels
(BJJ)
Nikita K N Jorritsma
(NKN)
Remi Verhaegh
(R)
Judith S Spanjaard
(JS)
Benjamin W Verboeket
(BW)
Duco Laane
(D)
Karlijn van Wessem
(K)
Wiebe Buitenwerf
(W)
Daan E J van Spengler
(DEJ)
Eva Mulder
(E)
Nienke Vrisekoop
(N)
Harry Heijerma
(H)
Harriët M R van Goor
(HMR)
Amely Daza Zabaleta
(A)
Frederiek van den Bos
(F)
Feikje Stiphout
(F)
Karin A H Kaasjager
(KAH)
Emma Rademaker
(E)
Meri R J Varkila
(MRJ)
Nikki de Mul
(N)
Olaf L Cremer
(OL)
Arjen Slooter
(A)
Maarten Limper
(M)
Helen Leavis
(H)
Eveline M Delemarre
(EM)
Aridaman Pandit
(A)
Femke van Wijk
(F)
Stefan Nierkens
(S)
Bernard N Jukema
(BN)
Chantal C Clark
(CC)
Arjan D Barendrecht
(AD)
Cor W Seinen
(CW)
Sandra Drost-Verhoef
(S)
Simone Smits
(S)
Naomi M J Parr
(NMJ)
Sylvie A E Sebastian
(SAE)
Arnold C Koekman
(AC)
Annet C van Wesel
(AC)
Erhard van der Vries
(E)
Coen Maas
(C)
Steven de Maat
(S)
Saskia Haitjema
(S)
Imo E Hoefer
(IE)
Gerjen H Tinnevelt
(GH)
Jeroen J Jansen
(JJ)
Informations de copyright
© 2023. The Author(s).
Références
Ann Transl Med. 2020 May;8(9):609
pubmed: 32566635
Cytometry A. 2021 May;99(5):435-445
pubmed: 33491921
J Leukoc Biol. 2021 Jan;109(1):99-114
pubmed: 33617030
J Med Microbiol. 1996 Feb;44(2):135-40
pubmed: 8642575
Future Microbiol. 2020 Feb;15:189-201
pubmed: 32065550
Yonago Acta Med. 2018 Dec 27;61(4):228-236
pubmed: 30636919
AIDS Res Hum Retroviruses. 2015 Jul;31(7):696-706
pubmed: 25891017
Clin Lab Haematol. 2005 Feb;27(1):41-6
pubmed: 15686506
Blood. 1997 Oct 15;90(8):3187-94
pubmed: 9376602
J Infect Dis. 2021 Feb 24;223(4):562-567
pubmed: 33206973
Int J Inflam. 2021 Nov 19;2021:1009231
pubmed: 34840718
J Infect. 2010 May;60(5):313-9
pubmed: 20206205
J Endotoxin Res. 2007;13(2):94-100
pubmed: 17621550
Cancer. 1950 Jan;3(1):32-5
pubmed: 15405679
Minerva Anestesiol. 2019 Sep;85(9):943-950
pubmed: 30871305
J Immunol Methods. 2019 Nov;474:112646
pubmed: 31419409
J Infect. 2016 Jan;72(1):1-18
pubmed: 26429736
Am J Respir Crit Care Med. 2012 Jul 1;186(1):65-71
pubmed: 22538802
J Infect. 2021 Apr;82(4):11-21
pubmed: 33610685
Scand J Infect Dis. 2005;37(11-12):882-9
pubmed: 16308225
Clin Chem Lab Med. 2009;47(8):903-16
pubmed: 19642859
Int J Infect Dis. 2013 Jan;17(1):e12-23
pubmed: 22940278
BMJ. 2005 Jul 2;331(7507):26
pubmed: 15979984
Ann Med. 2000 May;32(4):274-8
pubmed: 10852144
Ann Intensive Care. 2019 Jan 8;9(1):5
pubmed: 30623257
Crit Care. 2015 Jun 10;19:245
pubmed: 26059345
JAMA. 2016 Feb 23;315(8):762-74
pubmed: 26903335
Scand J Rheumatol. 2012 Mar;41(2):156-8
pubmed: 22420333