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nCD64 index as a prognostic biomarker for mortality in acute exacerbation of chronic obstructive pulmonary disease
1Dr. Dianjie Lin, No. 9677, The Olympic Mid Road,, Lixia District jinan Shandong, 250100 China, T: +86-0531-68773269, lindianjiesd@163.com.
Backgroound:
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide. However, there are still no easily obtained biomarkers for prognosis. As a high-affinity Fc receptor, CD64 is an early marker of immune response to bacterial infection, but its role in acute exacerbation of COPD (AECOPD) remains incompletely understood.
Objective:
We investigated the prognostic role of the neutrophial CD64 (nCD64) index in AECOPD patients.
Design:
Retrospective cross-sectional study of all patient admitted between January 2013 to May 2014.
Setting:
Provincial hospitals affiliated with a university.
Patients And Methods:
Clinical and laboratory data were collected in patients admitted for AECOPD and stable COPD patients, in whom nCD64 index was obtained. A receiver operating characteristics curve was used to determine the optimal cut-off levels for the nCD64 index that discriminated survivors versus nonsurvivors during index hospitalization, and during a post-discharge period of 12 months.
Main Outcome Measures:
nCD64 index level.
Results:
The white blood cell count, CRP (C-reactive protein (CRP) and PCT (procalcitonin) in AECOPD subjects (n=31) were all significantly higher than in controls (n=18) (P= 3.3 predicted in-hospital mortality with a sensitivity and specificity of 80% and 83%, respectively (area under the ROC=0.887; 95% confidence interval [CI]=0.721-0.972, P < .001). An nCD64 index of 3.3 upon admission as the optimal cut-off level to predict post-discharge mortality had a sensitivity and specificity of 83% and 75%, respectively (area under the ROC=0.842; 95% confidence interval [CI]=0.667-0.948, P < .001).
Conclusions:
An elevated nCD64 index was a reliable prognostic biomarker for both short-term and long-term mortality in patients admitted for AECOPD.
Limitations:
Retrospective design prevented collection of enough evidence to demonstrate infectious origin for COPD in every patient. Unsure whether nCD64 differed between bacterial and viral exacerbation.
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