title: Early diagnosis of intra-abdominal inflammation and sepsis by neutrophil CD64 expression in newborns.
abstract: BACKGROUND
  Newborn infants with intra-abdominal inflammation/sepsis often present with nonspecific signs in the early stages of the disease, but can rapidly develop life-threatening complications. A reliable 'early' biomarker would be invaluable.
  
  
  OBJECTIVE
  To evaluate the effectiveness of neutrophil CD64 as an 'early' biomarker of intra-abdominal inflammation/sepsis.
  
  
  METHODS
  Blood was collected from newborns with suspected intra-abdominal pathology for neutrophil CD64 and C-reactive protein (CRP) determination at the onset of clinical presentation and 24 h later. They were classified into three groups: intra-abdominal inflammation/sepsis (group 1), extra-abdominal sepsis (group 2) and nonsepsis (group 3). Between-group comparisons were made by Kruskal-Wallis and χ(2) tests. Receiver-operating characteristic curves and diagnostic utilities for single and combination of tests were determined.
  
  
  RESULTS
  310 infants were recruited (102, 34 and 174 in groups 1, 2 and 3, respectively). CD64 (conventional cutoff = 6,010 antibody-PE molecules bound/cell) had substantially better sensitivity (0.81 vs. 0.56) and negative predictive value (0.90 vs. 0.79) for diagnosing intra-abdominal sepsis than CRP, at presentation. Pairing CD64 with routine abdominal radiograph (AXR) substantially increased the sensitivity and negative predictive value for group 1 to 0.99 and 0.99, respectively. By adjusting the CD64 cutoff to 12,500 units, a substantial improvement in specificity could be achieved (0.62 to 0.80) without significantly compromising sensitivity (0.99 to 0.97).
  
  
  CONCLUSIONS
  CD64 is a sensitive and 'early' biomarker for diagnosing intra-abdominal inflammation/sepsis. Intra-abdominal catastrophes, including necrotizing enterocolitis, intestinal necrosis, perforation and peritonitis can confidently be excluded using CD64 and AXR early in the course of the disease.
authors: Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
authors: Hugh Simon
authors: HS
authors: Lam
authors: Samuel Po Shing
authors: SP
authors: Wong
authors: Hon Ming
authors: HM
authors: Cheung
authors: Winnie Chiu Wing
authors: WC
authors: Chu
authors: Raymond Pui On
authors: RP
authors: Wong
authors: Kit Man
authors: KM
authors: Chui
authors: Flora Yuen Big
authors: FY
authors: Liu
authors: Karen
authors: K
authors: Li
authors: Tai Fai
authors: TF
authors: Fok
authors: Pak Cheung
authors: PC
authors: Ng
mesh_terms: D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D017452:Receptors, IgG / Q000096:biosynthesis* / Q000097:blood; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000276:immunology
chemical_list: D015415:Biomarkers; D017452:Receptors, IgG