nCD64 index as a new early predictive biomarker for macrophage activation syndrome in adult-onset still’s disease

Macrophage activation syndrome (MAS) represents a severe and potentially life-threatening complication of adult-onset Still’s disease (AOSD), necessitating the identification of sensitive and specific biomarkers for early diagnosis. Our study found significantly elevated CD64 mRNA expression in neutrophils of AOSD patients compared to healthy controls (p = 0.029). The neutrophil CD64 index (nCD64 index) positively correlated with key clinical manifestations, including splenomegaly, sore throat, pulmonary infiltrates, and pericarditis. Effective treatments led to a rapid and significant decrease in the nCD64 index (p < 0.001). Logistic regression showed that an elevated nCD64 index is a risk factor for MAS (OR = 1.073, p = 0.003). ROC curve analysis indicated that the nCD64 index reliably distinguished AOSD patients with MAS (AUC = 0.877; cutoff = 32.09; p < 0.001) and combined utilization of nCD64 index, ferritin, and sIL-2R demonstrated a strong predictive value. Correlations with hospitalization length (r = 0.382, p < 0.001) and maximum glucocorticoid dose (r = 0.326, p = 0.003) were also observed. Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MAS in patients with an nCD64 index > 32.09 (p < 0.001). These findings suggest the nCD64 index is a promising biomarker for early identifying AOSD patients at risk of MAS, aiding in timely diagnosis and management.