Early Diagnosis of Sepsis Through Sepsis Markers and Sepsis Index Through Flow Cytometry Technology

Abstract

Objective: Sepsis is a major medical challenge, and remains a burden by showing minimal symptoms, non-specific manifestation which leads to the high-mortality rate. The major cause of high mortality rate is due to the diagnostic pitfalls. The sepsis mechanism involves immune suppression associated with multiorgan dysfunction, uncontrolled infection, and death. This study aims to use new parameters in diagnosis of sepsis particularly neutrophil CD64 (nCD64), monocyte human leukocyte antigen-DR (mHLA-DR), performed by flow cytometer. Methods:Available diagnostic tools such as blood culture (gold standard) and other tools are time-consuming which leads to death because the treatment is not commenced promptly due to unavailability of quick and accurate diagnostic procedures. To overcome such instances, there are different specific cell surface markers which are introduced to reveal sepsis at the earliest using flow cytometry technique. The newer technique allows determination of different cellular and functional pathological components of sepsis. Using this technology, a newer treatment modality (granulocyte macrophage colony-stimulating factor) can be used to reverse sepsis associated immune suppression. Results:The results suggested that the flow cytometric evaluation of nCD64, mHLA-DR expression assay, seems to be promising as comparison to other tools available for diagnosis. Conclusion:The pilot data suggest that the flow assay, "sepsis index" is a useful assay for diagnosing and discriminating sepsis in adult at intensive care unit settings in comparison to all the available current modalities of sepsis diagnosis. However, there are no other comparable parameters to diagnose early sepsis.

The use of neutrophil CD64 and monocyte HLA-DR sepsis index in the diagnosis of neonatal sepsis

“…Also, the study by Streimish et al [22] demonstrated that the sensitivity of CD64 was 78% and the specificity was 59%. The diagnostic efficacy of sensitivity and specificity nCD64 varied from 26 to 97% and 71 to 100%, respectively [24]. Thus, previous reports considered nCD64 a specific but weakly sensitive test for bacterial infection, and therefore, it is better to use it in combination with another more sensitive biological marker [25].…”

“…The mean SI in controls is 74% while in probable sepsis 105% and in proven sepsis is 180%. The pilot study by Chauhan et al [24] on adults in ICU units indicated that the diagnosis of sepsis is better through the combination of nCD64, mHLA-DR, and sepsis index for better diagnosis of these patients in comparison with all other available modalities. Similarly, the study by Pradhan et al [6] revealed that sepsis index was significantly higher in infected than noninfected neonates and healthy controls.…”

Early and Effective Diagnosis of Sepsis Using Flow Cytometry

“…It was concluded that flow analysis is superior to all other currently available modalities for detecting sepsis in adults. 24 …”

Evaluation of Changes in Leukocyte Surface Markers in the Early Diagnosis of Late-Onset Neonatal Sepsis

“…2,3 Early diagnosis of sepsis is important for making crucial decisions regarding the therapeutic administration of antimicrobials in a strategic and time-bound manner. 4 The most reliable diagnostic tool for neonatal sepsis is the blood culture test, which is considered the gold standard. 5 Commonly used nonculture-based diagnostic tests include total and differential white blood cell (WBC) counts, absolute and immature neutrophil counts, and the ratio of immature to total neutrophils.…”