A Study Of The Predictive Value Of Neutrophil CD64 Expression For Assessment Of Mortality Risk For Patients In The Intensive Care Unit

BackgroundNeutrophil CD64 has been shown to be a promising biomarker for bacterial infection and sepsis identification. However, the prognostic value of CD64 in predicting the likelihood of survival for patients in intensive care unit(ICU) is unclear. ObjectiveTo investigate the prognostic value of CD64 expression in predicting the mortality risk for patients in intensive care unit compared with other previous targets. MethodsThis study was approved by the Ethic Committee of Xin-Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. A total of 797 patients admitted to the ICU of Xin-Hua Hospital, Shanghai, China between Jan2011 and Dec2012 were enrolled in this study. We determined the Acute Physiology and Chronic Health Evaluation II(APACHE II) scores from these patients within 24 h after the admission and collected blood samples at the same day of hospitalization to measure the levels of neutrophil CD64, thyroid hormone and C-reactive protein(CRP). We assessed the association between APACHE II scores or these biomarkers and mortality of patients in the ICU. Receiver operating characteristic(ROC) curves were generated and the Area under the Curve(AUC) for each indicator was determined. Univariate logistic regression analyses and multivariate logistic regression analyses were performed to investigate the best prediction model.ResultsThe AUC for CD64 was 0.752 ± 0.026, which was higher than that of FT3(0.696 ± 0.028) and CRP(0.672 ± 0.026). APACHE II scores had the highest AUC(0.872 ± 0.018). The level of neutrophil CD64 expression positively associated with CRP and APACHE II, and negatively correlated with FT3. Multiple regression analysis revealed that APACHE II scores(Standard ? value = 0.183, P < 0.001), CD64(Standard ? value = 0.518, P <0.001) independently predicted ICU mortality. The accuracy of predicting the mortality risk is significantly improved when CD64 used as a biomarker in combination with the use of APACHE II scores. ConclusionThe elevation of the level of neutrophil CD64 indicated the increase of mortality risk of the patient. CD64 may be used as a biomarker in combination with the use of APACHE II scores to improve the accuracy of predicting mortality outcome for patients in the ICU.