Can procalcitonin be used to distinguish between disease flare and infection in patients with systemic lupus erythematosus: a systematic literature review

Abstract

Distinction between infection and febrile disease flare in patients with systemic lupus erythematosus (SLE) is fundamental but often difficult to make, because clinical presentation can be similar. A systematic review of all articles indexed in PubMed through October 2013 was performed, in order to examine the potential role of procalcitonin (PCT) for the discrimination between SLE flare and infection. Among the 12 papers identified, 5 articles reported on PCT levels in SLE patients without infection, 6 compared PCT levels between SLE patients with flare versus those with infection, and 1 analyzed PCT levels in active patients with and without bacterial infection. These data suggest the absence of correlation between PCT levels and SLE disease activity. Furthermore, PCT levels detected during disease flares are lower than those observed during bacterial infections. PCT can therefore be used accurately in the early differentiation between bacterial infection and flare in febrile SLE patients. Raised PCT levels ≥0.5 μg/L should strongly suggest bacterial infection in the context of SLE, keeping in mind the limited data available in case of hemophagocytic syndrome. Elevated PCT levels in SLE patients should always prompt a thorough search for sources of potential infection.

Differential Parameters between Activity Flare and Acute Infection in Pediatric Patients with Systemic Lupus Erythematosus

“…We also showed that compared to PCT, CRP is a more sensitive and speci c marker for diagnosing bacterial infections in SLE [41]. However, there had also been some reports that PCT is more speci c and has better diagnostic accuracy than CRP for infection in SLE [15,33,42]. Combination of these eight parameters resulted in a model with calculated AUC of 0.7886 and with sensitivity of 63.5% and speci city of 89.2% (Fig.…”

“…Limited information is available regarding plasma PCT levels in patients with active SLE. Patients with active SLE may have slightly increased PCT levels [15,18]. However, Garvand et al noted an unusual phenomenon PCT levels were high during macrophage activation syndrome (MAS) episodes in lupus ares [49].…”

“…There have been a number of studies on the predictive biological markers of SLE ares, including antidouble-stranded DNA antibodies (anti-dsDNA Ab), the complement system, anti-extractable nuclear antigen antibodies (anti-ENA Ab), cytokines, and chemokines [12,13]. For the prediction of infection in SLE patients, conventional biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate (ESR), procalcitonin [PCT]) [14][15][16][17][18] and new markers have been developed [19]. Several recent studies have focused on markers for differentiating between disease are and infection in febrile SLE patients [20][21][22].…”

Flares in systemic lupus erythematosus: diagnosis, risk factors and preventive strategies

“…19 A review of the literature published until 2014 indicated that raised PCT levels ≥0.5 μg/L should strongly suggest bacterial infection in the context of SLE. 20 However, there is limited data regarding the diagnostic accuracy of PCT in case of hemophagocytic syndrome, a severe condition which can mimic or complicate both lupus flare and infection. Another study suggests the use of the delta neutrophil index (DNI), which reflects the fraction of peripheral blood immature granulocytes, to differentiate infection from SLE flare.…”

Procalcitonin Testing in Rheumatology

“…Чувствительность и специфичность ПКТ состав-ляли 93,1 и 78,6 % соответственно. По данным I. Serio и соавт., среднее значение ПКТ у пациентов с почеч-ной недостаточностью было несколько выше, О б з о р ы чем в отсутствие последней, но не превышало поро-говых значений [32].…”