Development of Prediction Models for New Integrated Models and a Bioscore System to Identify Bacterial Infections in Systemic Lupus Erythematosus

Zhai, Xvwen; Feng, Min; Guo, Hui; Liang, Zheng; Wang, Yanlin; Qin, Yan; Wu, Yue; Zhao, Xiangcong; Gao, Chong

doi:10.3389/fcimb.2021.620372

Cited by 3 publications

(10 citation statements)

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“…We also excluded studies with overlapping data (e.g., abstracts that are later published as full-text articles or separately published studies that recruited patients from the same institution during the same period). 6,15…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…Table 1 provides details from the included studies. Most were cohort studies (six prospective 8,20,23,31,34,39 and twelve retrospective 6,22,[27][28][29][30]33,37,38,[40][41][42] ), seven cross-sectional studies, 7,21,[24][25][26]35,36,38 and one case-control study. 32…”

Section: Study Characteristicsmentioning

confidence: 99%

“…For our reference test, we found only two studies that had a low risk of bias. 6,41 All other studies included only culture or biochemical positive populations (may introduce bias as this is not entirely reflective of unconfirmed infections) or used clinical signs and symptoms, which may include the interpretation of ESR, CRP, or procalcitonin. All but seven studies had an unclear bias towards flow and timing as they did not specify at what point during the hospitalization inflammatory markers were drawn.…”

Section: Risk Of Bias and Applicabilitymentioning

confidence: 99%

“…7,8,20,21,23,24,[26][27][28][29][30][31][33][34][35][36][37]40,42 For applicability, we found that 11 studies had unclear concern applicability and one study had high concern for patient selection. 6,8,23,[28][29][30]33,35,38,39,41 The study with high concern was a case-control study that only included patients with tuberculosis meningitis and therefore not widely applicable. 32 All studies had low concern for applicability of the index and reference tests.…”

Section: Risk Of Bias and Applicabilitymentioning

confidence: 99%

“…4,5 There has been an ongoing interest in the use of these inflammatory markers in aiding in the diagnosis of infections in patients with SLE. [6][7][8][9] This is especially important with CRP, which can remain normal during SLE flares but typically increases in the setting of an infection. In contrast, other inflammatory markers such as PCT and ESR may change with SLE activity and could potentially limit their utility in diagnosing infection in SLE patients.…”

Section: Introductionmentioning

confidence: 99%

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The utility of erythrocyte sedimentation rate, C-reactive protein, and procalcitonin in detecting infections in patients with systemic lupus erythematosus: A systematic review

Bruera

Ventura

Agarwal

et al. 2022

Lupus

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Objectives We conducted a systematic review with metanalysis to investigate the utility of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) in diagnosing infections in hospitalized patients with SLE. Methods We searched Medline, Embase, Web of Science, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials (CENTRAL) with a search strategy developed by a medical librarian. We included retrospective, cross-sectional, case-control, and prospective studies in our analysis. We used the Quality Assessment of Diagnostic Studies (QUADAS-2) to assess for bias and applicability. We obtained mean differences, sensitivities, and specificities in our analysis. Results We included 26 studies in our analysis. Most studies had an unclear or high risk of bias and our results were widely heterogenous. For the diagnosis of infections, the CRP had a pooled sensitivity of 0.75 (95%CI 0.57-0.94) and specificity of 0.72 (0.59-0.85), PCT had a pooled sensitivity of 0.68 (95% CI 0.0.59–0.77) and specificity of 0.75 (0.59–0.90), and for ESR pooled estimates were not calculated but sensitivity ranged from 50 to 69.8 and specificity from 38.5 to 55.6. Modifying cut-offs improved sensitivities and specificities. The ESR, CRP, and PCT mean differences were all greater in infection groups versus non-infection (10.1, 95% CI 3.2–17.0; 46.8, 95% CI 36.5–57.0; 0.53, 95% CI 0.26–0.80; respectively). Discussion Poor sensitivities and specificities were observed for the evaluated biomarkers with substantial heterogeneity in the cut-offs used to determine infection. Although mean biomarker values were increased in the infection group compared with the non-infection, our findings do not support the widespread use of ESR, CRP, or PCT in diagnosing infection in hospitalized patients with SLE due to increased heterogeneity and risk of bias. Further investigation is needed.

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Section: Eligibility Criteriamentioning

confidence: 99%