• Mojca Groselj-Grenc, Alojz Ihan, Maja Pavcnik-Arnol, Andreja Natasa Kopitar, Tanja Gmeiner-Stopar, and Metka Derganc.
• Department of Pediatric Surgery and Intensive Care, University Medical Center, Zaloska 7, 1525 Ljubljana, Slovenia.mojca.groselj@kclj.si
• Intensive Care Med. 2009 Nov 1;35(11):1950-8.

ObjectiveTo compare the diagnostic accuracy of neutrophil and monocyte CD64 indexes (CD64in and CD64im) for sepsis in critically ill neonates and children with that of lipopolysaccharide-binding protein (LBP), procalcitonin (PCT) and C-reactive protein (CRP).Design And SettingProspective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU).PatientsForty-six neonates and 36 children with systemic inflammatory response syndrome (SIRS) and suspected infection, classified into two groups: those with bacterial sepsis (microbiologically proven or clinical sepsis) and those without bacterial sepsis (infection not supported by subsequent clinical course, laboratory data and microbiological tests).Interventions And MeasurementsFlow cytometric CD64in and CD64im, serum LBP, PCT and CRP measurement on 2 consecutive days from admission to the ICU.ResultsThere were 17 cases of bacterial sepsis in neonates and 24 cases of bacterial sepsis in children. All neonates and the majority of children were mechanically ventilated, and more than two-thirds of neonates with sepsis and one-third of children with sepsis needed inotropic/vasopressor drugs. The highest diagnostic accuracy for sepsis on the 1st day of suspected sepsis was achieved by LBP in neonates (0.86) and by CD64in in children (0.88) and 24 h later by CD64in in neonates (0.96) and children (0.98).ConclusionsNeutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.

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