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

• Published in: Lupus Vol. 27; no. 7; pp. 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: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2018; Sage Publications Ltd
• Subjects: Biomarkers; Emergency medical care; Enzyme-linked immunosorbent assay; Flow cytometry; Infections; Infectious diseases; Inflammation; Neutrophils; Polymerase chain reaction; Procalcitonin; Systemic lupus erythematosus; autoimmune diseases; disease activity; infections; Systemic lupus erythematosus; inflammation
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203318763740

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.