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Abstract

Background/Objective

Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS).

Methods

Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers.

Results

Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF (p = 0.041) and enzyme-linked immunosorbent assay (p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin (p = 0.047), neutrophil CD64 expression by flow cytometry (p = 0.037) and presepsin (p = 0.037) levels were observed in infected SLE patients.

Conclusions

High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.

Keywords

Systemic lupus erythematosus autoimmune diseases disease activity infections inflammation

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References

Barber

Gold

Fortin

. Infections in the lupus patient: Perspectives on prevention. Curr Opin Rheumatol 2011; 23: 358–365.

Alarcón

McGwin

Jr Bastian

et al.

Systemic lupus erythematosus in three ethnic groups. VII [correction of VIII]. Predictors of early mortality in the LUMINA cohort. LUMINA Study Group. Arthritis Rheum 2001; 45: 191–202.

Goldblatt

Chambers

Rahman

Isenberg

. Serious infections in British patients with systemic lupus erythematosus: Hospitalisations and mortality. Lupus 2009; 18: 682–689.

Noël

Lortholary

Casassus

et al.

Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001; 60: 1141–1144.

Cervera

Khamashta

Font

et al.

Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 82: 299–308.

Edwards

Lian

Badsha

Teh

Arden

Chng

. Hospitalization of individuals with systemic lupus erythematosus: Characteristics and predictors of outcome. Lupus 2003; 12: 672–676.

Ospina

Echeverri

Zambrano

et al.

Distinguishing infections vs flares in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2017; 56(Suppl 1): i46–i54.

Ricklin

Lambris

. Complement in immune and inflammatory disorders: Pathophysiological mechanisms. J Immunol 2013; 190: 3831–3838.

Markiewski

Lambris

. The role of complement in inflammatory diseases from behind the scenes into the spotlight. Am J Pathol 2007; 171: 715–727.

10.

Dai

Zhao

Gaskin

. Anti-dsDNA antibodies are one of the many autoantibodies in systemic lupus erythematosus. F1000Res 2015; 4. (F1000 Faculty Rev): 939.

11.

Harrison

. Erythrocyte sedimentation rate and C-reactive protein. Aust Prescr 2015; 38: 93–94.

12.

Cengić

Heljić

Rasić

Dilić

. Role of C-reactive protein in systemic lupus erythematosus [article in Croatian]. Med Arh 2002; 56: 147–149.

13.

Eberhard

Haubitz

Brunkhorst

Kliem

Koch

Brunkhorst

. Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 1997; 40: 1250–1256.

14.

Ali

Elnakeeb

Bendary

. Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis. Clin Chim Acta 2016; 460: 93–101.

15.

Shozushima

Takahashi

Matsumoto

Kojika

Okamura

Endo

. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother 2011; 17: 764–769.

16.

Gros

Roussel

Sauvadet

et al.

The sensitivity of neutrophil CD64 expression as a biomarker of bacterial infection is low in critically ill patients. Intensive Care Med 2012; 38: 445–452.

17.

Hochberg

. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725–1725.

18.

Levy

Fink

Marshall

et al.

2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.

19.

Rhodes

Evans

Alhazzani

et al.

Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304–377.

20.

Arriens

Wren

Munroe

Mohan

. Systemic lupus erythematosus biomarkers: The challenging quest. Rheumatology (Oxford) 2017; 56(Suppl 1): i32–i45.

21.

Liu

Hou

Chen

Wang

. Biomarkers for diagnosis of sepsis in patients with systemic inflammatory response syndrome: A systematic review and meta-analysis. Springerplus 2016; 5: 2091–2091.

22.

Wacker

Prkno

Brunkhorst

Schlattmann

. Procalcitonin as a diagnostic marker for sepsis: A systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426–435.

23.

Wang

Zeng

et al.

Neutrophil CD64 expression as a diagnostic marker for sepsis in adult patients: A meta-analysis. Crit Care 2015; 19: 245–245.

24.

Xiong

Wang

et al.

Neutrophil CD64 Index as a superior biomarker for early diagnosis of infection in febrile patients in the hematology department. Clin Chem Lab Med 2017; 55: 82–90.

25.

Zhang

. Accuracy of presepsin in sepsis diagnosis: A systematic review and meta-analysis. PLoS One 2015; 10: e0133057–e0133057.

26.

Zheng

Jiang

Gao

Tang

Zhang

. The accuracy of presepsin for the diagnosis of sepsis from SIRS: A systematic review and meta-analysis. Ann Intensive Care 2015; 5: 48–48.

27.

Gibot

Béné

Noel

et al.

Combination biomarkers to diagnose sepsis in the critically ill patient. Am J Respir Crit Care Med 2012; 186: 65–71.

28.

Linnik

Heilbrunn

et al.

Relationship between anti-double-stranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus. Arthritis Rheum 2005; 52: 1129–1137.

29.

Pan

Amigues

Lyman

et al.

A surge in anti-dsDNA titer predicts a severe lupus flare within six months. Lupus 2014; 23: 293–298.

30.

Müller

Peri

Doni

et al.

High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: Association of high decoy receptor levels with glucocorticoid administration. J Leukoc Biol 2002; 72: 643–649.

Neutrophil CD64 expression,procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS

Abstract

Background/Objective

Methods

Results

Conclusions

Keywords

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References