الفهرس 
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Abstract
Sepsis remains a critical medical problem which still in need for further diagnostic considerations.
In the past few years, attention has been directed toward new sepsis biomarkers to overcome the obstacles encountered with the conventional laboratory diagnostic modalities.
Leukocyte cell surface antigens including CD64, CD11b, CD14 and soluble fragment S-CD 14 (Presepsin) are on the top of the list of most researchable biomarkers.
The current study was designed to evaluate neutrophil CD64, neutrophil CD11b, monocyte CD14 and presepsin as early diagnostic markers and to rank their diagnostic performance aiming to decide which of these biomarkers is the most fitting for the routine daily requirement of our NICUs.
Two hundred forty-seven neonates were enrolled in the study selected from Ain Shams university hospitals NICUs during the period from November 2014 to November 2017, they were classified into six groups: group 1: healthy controls (n= 53), group 2: pathological controls (n= 49), group3: severe sepsis- septic shock group (n=37), group 4: blood culture proven sepsis group (n= 28), group 5: Clinically suspected sepsis group (n= 68) and group 6: non-sepsis SIRS group (n= 12).
The clinical criteria used to identify who were at sepsis included the presence of infection suspicion (sepsis risk factors) in context with two or more of the following SIRS signs: respiratory compromise, cardiovascular compromise and metabolic changes.
After an informed verbal consent of parents, neonates were subjected to history taking (through medical records), clinical examination and blood sampling were collected for blood culture, CBC, hs-CRP, nCD64, nCD11b, mCD14 and Presepsin measurement.
The diagnostic, monitoring and prognostic performance for each of the studied biomarkers were evaluated by using the different statistical modalities, besides to testing each biomarker stratification, prediction performance and the capability for the discrimination of sepsis-SIRS from the non-sepsis SIRS, in addition to their monitoring performance in the postoperative setting, which was also evaluated.
The present study results revealed that nCD64 and the presepsin are reliable early diagnostic and prognostic markers for neonatal septicemia achieving higher performance than the conventional parameters being used routinely in NICUs as nCD64% at a cutoff value 41.6% achieved sensitivity 94.7%, specificity 93.6 %, PPV 95.5 %, NPV 92.6 %, efficacy 94.3% and AUC 0.925. while Presepsin at a cutoff 686 pg/ml achieved sensitivity 82.7%, specificity 95.5%, PPV 95.4%, NPV 83.1%, efficacy 88.7% and AUC 0.887, respectively.
In addition, measurement of either of CD64/ Presepsin combined with hs-CRP would achieve much better performance than any of them alone.
The diagnostic performance of nCD64% is much more superior than presepsin in sepsis diagnosis, follow up, monitoring, stratification and in the differentiation between sepsis SIRS from non-sepsis SIRS cases. However, Presepsin still can be used as a more superior biomarker in the postoperative sepsis evaluation purpose.
Both nCD11b and mCD14 showed an intermediate validity results makes them less ideal for the diagnosis or the monitoring purpose, however mCD14 MFI revealed a preliminary promising role as a biomarker for sepsis prediction achieving sensitivity 66.7%, specificity 70.3% and efficacy 69.2%, which we recommend to be subjected for further research studies in the future.
In spite of nCD64 and presepsin are more fitting for the routine application as a part of the daily sepsis profile evaluation, both of them are more costly than CRP, but in fact, changing the antibiotics prescribed, catching the false blood culture results, avoiding performance of unnecessary organism typing and antibiotic screening in addition to saving the cost of nursing care, bed charges, treatment complications, and antibiotic resistance; this as a whole will absolutely make the expense of performing these new biomarkers is therefore more than compensated for by the potential savings generated.
Finally, we can conclude that the combined use of these newly studied sepsis biomarkers besides to the conventional parameters, including the gold standard; the microbiological cultures especially with using its rapid diagnostic techniques, in addition to the interpretations of their results in context with the clinical judgment will enhance greatly the management of sepsis patients in Ain Shams university hospital neonatal ICUs and hence, in the Egyptian NICUs as a whole.