Diagnostic value of procalcitonin for differentiation between bacterial infection and non-infectious inflammation in febrile patients with active adult-onset Still's disease

Dy, Chen; Ym, Chen; Wl, Ho; Hh, Chen; Shen, G-H; Jl, Lan

doi:10.1136/ard.2008.098335

Cited by 49 publications

(24 citation statements)

References 6 publications

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“…Procalcitonin was reported to have excellent sensitivity and specificity for bacterial fever in Still's disease (28). Our data demonstrating elevated procalcitonin in infections is consistent with this, although the number of subjects with infection was low.…”

Section: Discussionsupporting

confidence: 80%

Comparison of biomarkers for systemic juvenile idiopathic arthritis

Shenoi

Ni³

et al. 2015

Pediatr Res

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Background: Differentiation of systemic juvenile idiopathic arthritis (SJIA) fever from other childhood fevers is often delayed due to the lack of reliable, specific biomarkers. We hypothesized that PD-L1 expression is dysregulated in SJIA monocytes and compared it to other candidate SJIA biomarkers. Methods: This pilot study enrolled children with fever without source and compared PD-L1 expression on myeloid cells to C-reactive protein, erythrocyte sedimentation rate, leukocyte counts, S100A12, S100A8, S100A9, calprotectin, and procalcitonin. Logistic regression models were fit to test SJIA diagnosis with each marker used as an independent predictor. Receiver operating characteristic curves and area under curve were calculated. Gene expression profiling on a subset of samples was performed. results: Twenty subjects (10 active SJIA, 10 febrile non-SJIA) were enrolled. S100 proteins were significantly elevated in SJIA with >80% sensitivity and >90% specificity. PD-L1 expression was significantly lower in SJIA. Other markers were not specific for SJIA. On exploratory gene analysis, 106 genes were significant for SJIA association, and several of these are associated with immune response pathways. conclusion: In this small cohort, S100 proteins were specific diagnostic biomarkers for SJIA in children with fever. Decreased PD-L1 surface expression on circulating myeloid cells in SJIA suggests possible mechanism for loss of peripheral immune regulation.

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Section: Discussionsupporting

confidence: 80%

Comparison of biomarkers for systemic juvenile idiopathic arthritis

Shenoi

Ni³

et al. 2015

Pediatr Res

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“…It has been reported that serum PCT levels are higher in patients with active antineutrophil cytoplasmic antibody-associated vasculitis and in patients with AOSD (22, 23). Different PCT levels can be expected in different autoimmune diseases.…”

Section: Discussionmentioning

confidence: 99%

Serum Procalcitonin for Differentiating Bacterial Infection from Disease Flares in Patients with Autoimmune Diseases

et al. 2011

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Early differentiation between bacterial infections and disease flares in autoimmune disease patients is important due to different treatments. Seventy-nine autoimmune disease patients with symptoms suggestive of infections or disease flares were collected by retrospective chart review. The patients were later classified into two groups, disease flare and infection. C-reactive protein (CRP) and serum procalcitonin (PCT) levels were measured. The CRP and PCT levels were higher in the infection group than the disease flare group (CRP,11.96 mg/dL ± 9.60 vs 6.42 mg/dL ± 7.01, P = 0.003; PCT, 2.44 ng/mL ± 6.55 vs 0.09 ng/mL ± 0.09, P < 0.001). The area under the ROC curve (AUC; 95% confidence interval) for CRP and PCT was 0.70 (0.58-0.82) and 0.84 (0.75-0.93), which showed a significant difference (P < 0.05). The predicted AUC for the CRP and PCT levels combined was 0.83, which was not significantly different compared to the PCT level alone (P = 0.80). The best cut-off value for CRP was 7.18 mg/dL, with a sensitivity of 71.9% and a specificity of 68.1%. The best cut-off value for PCT was 0.09 ng/mL, with a sensitivity of 81.3% and a specificity of 78.7%. The PCT level had better sensitivity and specificity compared to the CRP level in distinguishing between bacterial infections and disease flares in autoimmune disease patients. The CRP level has no additive value when combined with the PCT level when differentiating bacterial infections from disease flares.

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“…The failure of statins to influence APR incidence is perhaps less surprising because this lack of effect has also been reported from a small clinical trial (17) and probably reflects the substantial first-pass liver metabolism of those statins in widespread clinical use. The protective effect of concomitant use of calcitonin might be related to its analgesic effect (18) or to the fact that procalcitonin is itself secreted in many inflammatory conditions (19). Possibly prior calcitonin use desensitizes the inflammatory response.…”

Section: Discussionmentioning

confidence: 98%