Differential parameters between activity flare and acute infection in pediatric patients with systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) patients are vulnerable to infections. We aim to explore the approach to differentiate active infection from disease activity in pediatric SLE patients. Fifty pediatric SLE patients presenting with 185 clinical visits were collected. The associations between both clinical and laboratory parameters and the outcome groups were analyzed using generalized estimating equations (GEEs). These 185 visits were divided into 4 outcome groups: infected-active (n = 102), infected-inactive (n = 11), noninfected-active (n = 59), and noninfected-inactive (n = 13) visits. Multivariate GEE (generalized estimating equation) analysis showed that SDI, SLEDAI-2K, neutrophil‐to‐lymphocyte ratio (NLR), hemoglobin, platelet, RDW-to-platelet ratio (RPR), and C3 are predictive of flare (combined calculated AUC of 0.8964 and with sensitivity of 82.2% and specificity of 90.9%). Multivariate GEE analysis showed that SDI, fever temperature, CRP, procalcitonin (PCT), lymphocyte percentage, NLR, hemoglobin, and renal score in SLEDAI-2k are predictive of infection (combined calculated AUC of 0.7886 and with sensitivity of 63.5% and specificity of 89.2%). We can simultaneously predict 4 different outcome with accuracy of 70.13% for infected-active group, 10% for infected-inactive group, 59.57% for noninfected-active group, and 84.62% for noninfected-inactive group, respectively. Combination of parameters from four different domains simultaneously, including inflammation (CRP, ESR, PCT), hematology (Lymphocyte percentage, NLR, PLR), complement (C3, C4), and clinical status (SLEDAI, SDI) is objective and effective to differentiate flares from infections in pediatric SLE patients.

CRP Serum Levels Are Associated with High Cardiometabolic Risk and Clinical Disease Activity in Systemic Lupus Erythematosus Patients

“…The role of CRP in clinical disease activity in SLE is still complex and controversial; some studies reported that CRP levels are normal or only modestly elevated in active SLE and that there is no relationship between CRP levels and clinical disease activity [ 12 , 13 ]. In contrast, we found that patients with active SLE had higher CRP levels than inactive SLE patients; additionally, we observed a positive correlation between Mex-SLEDAI score and CRP levels when we adjusted for some variables that could influence it, such as age, fat mass, and BMI [ 32 ].…”

“…However, CRP’s role in active SLE is still complex and controversial, some studies have reported that CRP levels are normal or modestly elevated in active SLE, and that there is no relationship between CRP levels and clinical disease activity [ 12 , 13 ]. Nevertheless, it is widely described that in active SLE patients there is an increase in inflammatory cytokines such as IL-6, which could directly drive the CRP serum levels, suggesting a potential relationship between the increase in IL-6 in the active SLE and higher CRP serum levels [ 7 ].…”

Recurrent Temporal Infections: The Link to Systemic Lupus Erythematosus

“…The present case had triggered a controversy on whether the pyomyositis and osteomyelitis was a genuine infection or the SLE disease activity. There are many biomarkers associated with the infection as well as for SLE disease (non-infection inflammation), such as C-reactive protein, procalcitonin level, leukocyte count, complement levels, anti-dsDNA, and Systemic Lupus Erythematosus Disease Activity Index score [ 31 – 33 ]. Among those, C-reactive protein was shown as a potent marker to diagnose infection in patients with SLE [ 31 , 32 ].…”

Peripheral blood cells RNA-seq identifies differentially expressed gene network linked to lymphocyte subsets alterations and active lupus nephritis associated with declines in renal function

“…These exclusion criterion eliminate confounding factors that could have affected the study outcomes. Any episodes that fulfilled the definition of acute infections during follow-up were also excluded [ 18 ].…”