Study of CD64 and HLA-DR as Early Detection Markers of Sepsis in Hepatic ICU Patients

Abstract

Background and study aim: Sepsis is the most common cause of death in liver cirrhosis patients. Aim: Evaluation of neutrophil and monocyte CD64 and HLA-DR as early biomarkers predicting sepsis in liver cirrhosis. Patients and Methods: This case-control study involved 70 cirrhotic patients (35 with sepsis and 35 without) and 30 healthy individuals. Laboratory studies were performed, including CD64 and HLA-DR using flow cytometry along with sepsis index (SI). Results: Patients were mainly males (80%), aged 62.17 ± 7.56, and 64.69 ± 11.64 years in group 1&2 respectively. Mono CD64% at Cut-off: >62.9 showed AUC: 0.676, Sensitivity: 80.0%, Specificity: 60.0%, PPV: 66.7%, and NPV: 75.0%, while Mono CD64 MFI at Cut-off >9.5 showed AUC: 0.659, Sensitivity: 94.29%, Specificity: 37.14%, PPV: 60.0%, and NPV: 86.7%. Combinations of CRP+ Lactate+ Mono CD64%+ Mono revealed AUC: 0.929, Sensitivity: 82.86%, Specificity: 91.43%, PPV: 90.6%, and NPV: 84.2% Mono CD64% and CD64 MFI (0.003; 0.03] respectively. Regression analysis defined Mono CD64% >62.9 (OR 6], Mono CD64 MFI >9.5 (OR 9.75) CRP >32.4 (OR 13.5), lactate>1.93 (OR 12.08) and ALBI score>0.01 (OR 6) all as factors affecting early sepsis in cirrhosis. Conclusion: Mono CD64% and Mono CD64 MFI proved efficacy as early septic biomarkers with higher efficacy when combined with traditional inflammatory markers in liver cirrhosis patients.