TY - JOUR
T1 - Point-of-care neutrophil CD64 as a rule in diagnostic test for bacterial infections in the emergency department
AU - the COVPACH study group
AU - van de Ven, N. L.M.
AU - Bongers, S. H.
AU - Spijkerman, R.
AU - Koenderman, L.
AU - Leenen, L. P.H.
AU - Hietbrink, F.
AU - Nijdam, Thomas M.P.
AU - Bindels, Bas J.J.
AU - Jorritsma, Nikita K.N.
AU - Verhaegh, Remi
AU - Spanjaard, Judith S.
AU - Verboeket, Benjamin W.
AU - Laane, Duco
AU - van Wessem, Karlijn
AU - Buitenwerf, Wiebe
AU - van Spengler, Daan E.J.
AU - Mulder, Eva
AU - Vrisekoop, Nienke
AU - Heijerma, Harry
AU - van Goor, Harriët M.R.
AU - Daza Zabaleta, Amely
AU - van den Bos, Frederiek
AU - Stiphout, Feikje
AU - Kaasjager, Karin A.H.
AU - Rademaker, Emma
AU - Varkila, Meri R.J.
AU - de Mul, Nikki
AU - Cremer, Olaf L.
AU - Slooter, Arjen
AU - Limper, Maarten
AU - Leavis, Helen
AU - Delemarre, Eveline M.
AU - Pandit, Aridaman
AU - van Wijk, Femke
AU - Nierkens, Stefan
AU - Jukema, Bernard N.
AU - Clark, Chantal C.
AU - Barendrecht, Arjan D.
AU - Seinen, Cor W.
AU - Drost-Verhoef, Sandra
AU - Smits, Simone
AU - Parr, Naomi M.J.
AU - Sebastian, Sylvie A.E.
AU - Koekman, Arnold C.
AU - van Wesel, Annet C.
AU - van der Vries, Erhard
AU - Maas, Coen
AU - de Maat, Steven
AU - Haitjema, Saskia
AU - Hoefer, Imo E.
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - INTRODUCTION: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.
AB - INTRODUCTION: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.
KW - Bacterial infections
KW - COVID-19
KW - Inflammation
KW - nCD64
KW - Point of care immunology
KW - Viral infections
UR - https://www.scopus.com/pages/publications/85150088232
U2 - 10.1186/s12873-023-00800-2
DO - 10.1186/s12873-023-00800-2
M3 - Article
C2 - 36915043
AN - SCOPUS:85150088232
SN - 1471-227X
VL - 23
JO - BMC emergency medicine
JF - BMC emergency medicine
IS - 1
M1 - 28
ER -