Monocyte CD64 Does Not Enhance Neutrophil CD64 as a Diagnostic Marker in Neonatal Sepsis
Bibliographic record
Abstract
To The Editors: We were intrigued by the recent paper that suggested that monocyte CD64 (mCD64) could enhance the ability of neutrophil CD64 (nCD64) as a diagnostic marker for neonatal sepsis, when expressed as median m/n CD64 values.1 As part of our recent investigations into the role of nCD64 as a diagnostic marker for neonatal sepsis,2,3 we had also collected data on mCD64 measurements. Hence, we went back to analyze our mCD64 data to assess whether it would improve our diagnostic abilities. We had 919 episodes of sepsis evaluations with both nCD64 and mCD64 measurements available. Of these 919, 533 episodes were of early-onset sepsis, of which 2 were culture proven. Of 386 episodes of late-onset sepsis, 46 were culture proven. Hence, we had a total of 48 episodes of culture-proven sepsis available for analysis. As we have done previously,2,3 we generated area under the curve (AUC) for receiver operator characteristic curves using nCD64 and mCD64, controlling for birth weight as a predictor. We found similar values for the AUC 0.88 and 0.82 for nCD64 and mCD64, respectively. Combining the two, even when they were correlated, gave similar results; an AUC of 0.88. We also calculated the AUC using the m/nCD64 ratio and obtained a result of 0.83. This value was similar to that of mCD64 alone, but less than that of nCD64 alone. Next, we performed a simple correlation of nCD64 and mCD64, regardless of repeated measurements, and obtained an R = 0.75, P < 0.0001 (Fig. 1). We concluded that mCD64 appeared to have no additional value in predicting culture-proven neonatal sepsis compared with nCD64 measurements. Our results support reports by other investigators where the mCD64 performed on par or below that of nCD64 as a diagnostic marker for neonatal sepsis.4,5 We speculate the differences in our results, compared with the earlier study,1 could be because of the different methodology used for measuring and analyzing mCD64. Our monocyte and neutrophil CD64 values were generated using a different antibody and were derived using an additional isotype control-based index to control for nonspecific fluorescence, often a significant issue for quantitating monocyte surface marker fluorescence. In addition, the differences in the types of microorganisms (which could instigate variable response in the n and/or m CD64 expression) isolated from the neonates at these 2 sites could also be another potential reason for the discrepant results. Additional studies are required to assess the utility, if any, of mCD64 in addition to that of nCD64, in the diagnosis of neonatal sepsis.FIGURE 1: Simple correlation between neutrophil and mCD64, regardless of repeated measurements. R = 0.75; P < 0.0001.Fang-Yong Li, MPH Veronika Shabanova, MPH Yale Center for Analytical Sciences Chao Wang, BS Henry M. Rinder, MD Department of Laboratory Medicine Yale University School of Medicine Vineet Bhandari, MD, DM Division of Perinatal Medicine Department of Pediatrics Yale University School of Medicine New Haven, CT
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.052 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.007 | 0.009 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".