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

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 activi...

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Bibliographic Details
Published in:Lupus 2018-06, Vol.27 (7), p.1130-1139
Main Authors: Echeverri, A, Naranjo-Escobar, J, Posso-Osorio, I, Aguirre-Valencia, D, Zambrano, D, Castaño, G L, Martínez, J D, Cañas, C A, Tobón, G J
Format: Article
Language:English
Subjects:
Biomarkers
Emergency medical care
Enzyme-linked immunosorbent assay
Flow cytometry
Infections
Infectious diseases
Inflammation
Neutrophils
Polymerase chain reaction
Procalcitonin
Systemic lupus erythematosus
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Summary: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.
ISSN:0961-2033
1477-0962
DOI:10.1177/0961203318763740