Neutrophil and monocyte CD64 indexes,  lipopolysaccharide-binding protein,  procalcitonin and C-reactive protein in sepsis  of critically ill neonates and children.
OBJECTIVE
To compare the diagnostic accuracy of neutrophil and monocyte CD64 indexes (CD64in and CD64im) for sepsis in critically ill neonates and children with that of lipopolysaccharide-binding protein (LBP), procalcitonin (PCT) and C-reactive protein (CRP).


METHODS
Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU).


METHODS
Forty-six neonates and 36 children with systemic inflammatory response syndrome (SIRS) and suspected infection, classified into two groups: those with bacterial sepsis (microbiologically proven or clinical sepsis) and those without bacterial sepsis (infection not supported by subsequent clinical course, laboratory data and microbiological tests).


METHODS
Flow cytometric CD64in and CD64im, serum LBP, PCT and CRP measurement on 2 consecutive days from admission to the ICU.


RESULTS
There were 17 cases of bacterial sepsis in neonates and 24 cases of bacterial sepsis in children. All neonates and the majority of children were mechanically ventilated, and more than two-thirds of neonates with sepsis and one-third of children with sepsis needed inotropic/vasopressor drugs. The highest diagnostic accuracy for sepsis on the 1st day of suspected sepsis was achieved by LBP in neonates (0.86) and by CD64in in children (0.88) and 24 h later by CD64in in neonates (0.96) and children (0.98).


CONCLUSIONS
Neutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.
Groselj-Grenc
Mojca
M
Department of Pediatric Surgery and Intensive Care, University Medical Center, Zaloska 7, 1525 Ljubljana, Slovenia.mojca.groselj@kclj.si
Ihan
Alojz
A
Pavcnik-Arnol
Maja
M
Kopitar
Andreja Natasa
AN
Gmeiner-Stopar
Tanja
T
Derganc
Metka
M
D000209:Acute-Phase Proteins; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002352:Carrier Proteins / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D009000:Monocytes / Q000378:metabolism; D009504:Neutrophils / Q000378:metabolism; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D017452:Receptors, IgG / Q000097:blood*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000382:microbiology; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D015415:Biomarkers; D002097:C-Reactive Protein; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D017452:Receptors, IgG; D000099231:Lipopolysaccharide-Binding Protein; C000606589:CALCA protein, human