nCD64 index as a prognostic biomarker for mortality in acute exacerbation of chronic obstructive pulmonary disease.

Abstract

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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