Pentraxin 3 is more accurate than C-reactive protein for Takayasu arteritis activity assessment: A systematic review and meta-analysis

Abstract

Aims Whether the circulating levels of pentraxin 3 (PTX3), an acute phase reactant (APR), are higher in active Takayasu arteritis (TAK), and if so, whether PTX3 is more accurate than C-reactive protein (CRP) in TAK activity assessment has been investigated in this study. Study design Research works such as PubMed, Embase, ScienceDirect, Cochrane Library, and two Chinese literature databases (CNKI and WanFang) were searched for studies conducted till August 30th, 2019. Two investigators searched the studies independently, who evaluated the quality of the study using the Newcastle–Ottawa scale (NOS) and extracted data. Pooled standard mean difference (SMD) and diagnostic indexes, with a 95% confidence interval (CI), were calculated using a random-effect model. Results Totally, 8 studies involving 473 TAK (208 active and 265 inactive TAK) patients and 252 healthy controls were eventually included in the meta-analysis. PTX3 level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled SMD of 0.761 (95% CI = 0.38–1.14, p<0.0001; I2 = 68%, p of Q test = 0.003). And there was no publication bias. Among the 8 studies, 5 studies identified active TAK with both PTX3 and CRP. The pooled sensitivity, specificity, and AUC values of PTX3 in active TAK diagnosis were higher than those of CRP (0.78 [95% CI = 0.65–0.87] vs. 0.66 [95% CI = 0.53–0.77], p = 0.012; 0.85 [95% CI = 0.77–0.90] vs. 0.77 [95% CI = 0.56–0.90], p = 0.033; 0.88 [95% CI = 0.85–0.90] vs. 0.75 [95% CI = 0.71–0.79], p < 0.0001). It showed potential publication bias using Egger’s test (p of PTX3 = 0.031 and p of CRP = 0.047). Conclusions PTX3 might be better than CRP in the assessment of TAK activity. Yet, it should be cautious before clinical use for moderate heterogeneity and potential publication bias of the meta-analysis.

Biomarker Changes and Molecular Signatures Associated with Takayasu Arteritis Following Treatment with Glucocorticoids and Tofacitinib

“… 20 Moreover, PTX3 has been reported to be superior to CRP as a disease activity biomarker in TAK. 21 In the present study, PTX3 was also significantly higher in TAK patients, which was consistent with previous reports. 3 In addition, the close relationship between PTX3 and NIH score also demonstrated it as a biomarker for TAK disease activity.…”

“…It has reported that PTX3 levels were increased among patients with TAK and closely related with vascular inflammation. 20 , 21 Higher levels of PTX3 may increase the risk of vascular involvement in TAK and GCA. 20 Moreover, PTX3 has been reported to be superior to CRP as a disease activity biomarker in TAK.…”

Current Diagnosis and Management of Takayasu Arteritis

“…19) A recent meta-analysis involving 8 studies showed PTX3 might be a better marker than CRP in assessing disease activity with better pooled sensitivity, specificity, and AUC values (78% versus 66%, 85% versus 77%, 0.88 versus 0.75) than those of CRP. 20) But PTX3 is a nonspecific biomarker, because its levels are raised in several autoimmune diseases. 19) Table II summarises available biomarkers for assessing TAK.…”

“…19) Table II summarises available biomarkers for assessing TAK. 11,14,15,[17][18][19][20][21][22][23][24] Autoantibodies: Even though TAK is predominantly a disease of cellular immunity, newer evidence showed the presence of B cell subsets in affected vascular tissues. This led to an extensive search for specific autoantibodies in TAK which has until now been largely unsuccessful.…”

Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis

“…A systematic review with meta-analysis of 473 patients with TAK (208 with active disease) from eight studies reported a moderate effect size for differences in levels of circulating pentraxin-3 between active and inactive TAK (standardized mean difference 0.761, 95% CI 0.300–1.140, I 2 68%). Further, from five of these studies which reported both pentraxin-3 and CRP, the pooled sensitivity (78% vs. 66%), specificity (85% vs. 77%) and AUC (0.88, 95% CI 0.85–0.90 vs. 0.75, 95% CI 0.71–0.79) were better for pentraxin-3 than for CRP [ 101 ]. Some studies [ 100 ], but not others [ 97 ], have demonstrated a correlation between circulating levels of CRP and pentraxin-3 in TAK.…”