Abstract
BackgroundNeutrophil CD64 is widely described as an accurate biomarker for the diagnosis of infection in patients with septic syndrome. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of neutrophil CD64, comparing it with C-reactive protein (CRP) and procalcitonin (PCT) for the diagnosis of infection in adult patients with septic syndrome, based on sepsis-2 criteria. We searched the PubMed and Embase databases and Google Scholar. Original studies reporting the performance of neutrophil CD64 for sepsis diagnosis in adult patients were retained. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and hierarchical summary receiver operating characteristic (SROC) curve were calculated.ResultsWe included 14 studies (2471 patients) from 2006 to 2017 in the meta-analysis. The pooled sensitivity and specificity of neutrophil CD64 for diagnosing infection in adult patients with septic syndrome were 0.87 (95% CI 0.80–0.92) and 0.89 (95% CI 0.82–0.93), respectively. The area under the SROC curve and the DOR were 0.94 (95% CI 0.92–0.96) and 53 (95% CI 22–128), respectively. There was significant heterogeneity between the studies included. Subgroup analyses showed that this heterogeneity was due to differences in sample size and the proportions of patients with sepsis included in the studies. Six studies (927 patients) compared neutrophil CD64 and CRP determinations, and six studies (744 patients) compared neutrophil CD64 and PCT determinations. The area under the SROC curve was larger for neutrophil CD64 than for CRP (0.89 [95% CI 0.87–0.92] vs. 0.84 [95% CI 0.80–0.88], P < 0.05) or PCT (0.89 [95% CI 0.84–0.95] vs. 0.84 [95% CI 0.79–0.89], P < 0.05).ConclusionsIn adult patients with septic syndrome, neutrophil CD64 levels are an excellent biomarker with moderate accuracy outperforming both CRP and PCT determinations.
Highlights
Neutrophil cluster of differentiation 64 (CD64) is widely described as an accurate biomarker for the diagnosis of infection in patients with septic syndrome
We evaluated the accuracy of neutrophil CD64 as a biomarker for diagnosing infection in adult patients with septic syndrome based on sepsis-2 criteria, by performing a systematic literature review and a meta-analysis, comparing the diagnostic value of neutrophil CD64 with that of C-reactive protein (CRP) and PCT
Twenty-three articles were subjected to further review, and nine articles were excluded (3 were not diagnostic studies, 2 did insufficient information for the construction of a 2 × 2 contingency table, 3 were not relevant to the use of neutrophil CD64 as a sepsis biomarker, and 1 did not use the serum sample)
Summary
Neutrophil CD64 is widely described as an accurate biomarker for the diagnosis of infection in patients with septic syndrome. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of neutrophil CD64, comparing it with C-reactive protein (CRP) and procalcitonin (PCT) for the diagnosis of infection in adult patients with septic syndrome, based on sepsis-2 criteria. Original studies reporting the performance of neutrophil CD64 for sepsis diagnosis in adult patients were retained. A biomarker is urgently required to improve the early diagnosis of infection in patients with septic syndrome. Many studies have identified neutrophil cluster of differentiation 64 (CD64) as a candidate biomarker for bacterial infection and sepsis [6,7,8]. Bacterial infection or sepsis leads to an increase in CD64 expression on activated PMNs [6]. Neutrophil CD64 is considered a candidate biomarker of sepsis suitable for use in clinical practice
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