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

Abstract

<title>Abstract</title> Background Sepsis is the commonest 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. 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 and 64.69 years respectively. <bold>Mono CD64%</bold> at <bold>Cut-off</bold>: &gt;62.9 showed <bold>AUC</bold>: 0.676, <bold>Sensitivity</bold>: 80.0%, <bold>Specificity</bold>: 60.0%, <bold>PPV</bold>: 66.7%, and <bold>NPV</bold>: 75.0%. while <bold>Mono CD64 MFI</bold> at <bold>Cut-off</bold> &gt; 9.5 shoed <bold>AUC</bold>: 0.659, <bold>Sensitivity</bold>: 94.29%, <bold>Specificity</bold>: 37.14%, <bold>PPV</bold>: 60.0%, and <bold>NPV</bold>: 86.7%. Combinations of <bold>CRP + Lactate + Mono CD64%+ Mono CD64 MFI revealed AUC</bold>: 0.929, <bold>Sensitivity</bold>: 82.86%, <bold>Specificity</bold>: 91.43%, <bold>PPV</bold>: 90.6%, and <bold>NPV</bold>: 84.2% Mono CD64% and CD64 MFI (0.003; 0.03) respectively. Regression analysis defined Mono CD64% &gt;62.9 (OR 6), Mono CD64 MFI &gt; 9.5 (OR 9.75), CRP &gt; 32.4 (OR 13.5), lactate &gt; 1.93 (OR 12.08), and ALBI score &gt; 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.