Serum procalcitonin and C-reactive protein levels as diagnostic markers for distinguishing bacterial infections from lupus flares in systemic lupus erythematosus: A systematic review and meta‑analysis

Chen, Yuting; Shen, Jiran; Yang, Hui; Xu, Shanshan; Ma, Yubo; Pan, Faming

doi:10.1016/j.intimp.2021.108304

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…A retrospective study with 177 patients measuring PCT and CRP found that CRP was an effective marker for diagnosing infection in SLE patients [ 35 ]. However, other studies have demonstrated that PCT has a negative predictive value for bacterial infection in active SLE [ 36 ]. Our patient had normal CRP and PCT, making an infectious process less likely.…”

Section: Discussionmentioning

confidence: 99%

A Challenging Diagnosis of Febrile Pancytopenia in a Patient With a History of Autoimmune Disease

Guevara¹,

Chang²,

Castelar³

et al. 2023

Cureus

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Pancytopenia is a hematologic condition characterized by a decrease in all three peripheral blood cell lines. There are many causes of pancytopenia, and the proper approach is required for accurate diagnosis. Brucellosis and systemic lupus erythematosus (SLE) are both diseases that can initially present as pancytopenia, both of which require a targeted workup to diagnose. Due to the immune system's complexity, many distinct diseases may have similar symptomatology. Furthermore, infections and rheumatological diseases can stimulate the same molecular pathways and trigger T and B cells. This creates a cross-reactivity between microbial peptides and self-peptides, allowing the spread of microbial-specific T cells that can also respond to self-peptides. Brucellosis has broad clinical manifestations, often mimicking many other diseases, such as rheumatoid arthritis, sarcoidosis, and SLE. In addition, brucellosis-induced autoantibody production has been described as a triggering factor for immunologic reactions, elevating rheumatological markers by a poorly understood mechanism. Finally, SLE is a well-known medical condition that can mimic several medical conditions, including brucellosis. We present a case of a young patient who was admitted with febrile pancytopenia. The patient also had IgM antibodies positive for brucellosis and high immune markers for SLE. She was treated for both diseases, and afterward, in retrospect, it was confirmed that the patient did not have acute brucellosis.

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Section: Discussionmentioning

confidence: 99%

A Challenging Diagnosis of Febrile Pancytopenia in a Patient With a History of Autoimmune Disease

Guevara¹,

Chang²,

Castelar³

et al. 2023

Cureus

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“…47 A recently published meta-analysis investigated the use of PCT and CRP levels is diagnosing bacterial infections in patients with SLE flares. 48 In our meta-analysis we used a different patient population as we included all hospitalized SLE patients (with or without flare). We also used more stringent criteria.…”

Section: Discussionmentioning

confidence: 99%

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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“…However, the diagnostic value of PCT and CRP in the identification of bacterial infection in SLE remains unsettled. 67,68 Mannose Binding Lectin (MBL)…”

Section: Elevated Procalcitonin (Pct)mentioning

confidence: 99%

A Framework to Overcome Challenges in the Management of Infections in Patients with Systemic Lupus Erythematosus

Rao¹,

Mikdashi²

2023

OARRR

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Infections remain one of the leading causes of death in systemic lupus erythematosus (SLE), despite awareness of factors contributing to increased susceptibility to infectious diseases in SLE. Clinicians report challenges and barriers when encountering infection in SLE as certain infections may mimic a lupus flare. There are no evidence-based practice guidelines in the management of fever in SLE, with suboptimal implementations of evidence-based benefits related to infectious disease control and/or prevention strategies in SLE. Vigilance in identifying an opportunistic infection must be stressed when confronted by a diagnostic challenge during a presentation with a febrile illness in SLE. A balanced approach must focus on management of infections in SLE, and reduction in the glucocorticoids dose, given the need to control lupus disease activity to avoid lupus related organ damage and mortality. Clinical judgement and application of biomarkers of lupus flares could reduce false positives and overdiagnosis and improve differentiation of infections from lupus flares. Further precision-based risk and screening measures must identify individuals who would benefit most from low dose immunosuppressive therapy, targeted immune therapy, and vaccination programs.

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Serum procalcitonin and C-reactive protein levels as diagnostic markers for distinguishing bacterial infections from lupus flares in systemic lupus erythematosus: A systematic review and meta‑analysis

Cited by 8 publications

References 28 publications

A Challenging Diagnosis of Febrile Pancytopenia in a Patient With a History of Autoimmune Disease

A Challenging Diagnosis of Febrile Pancytopenia in a Patient With a History of Autoimmune Disease

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

A Framework to Overcome Challenges in the Management of Infections in Patients with Systemic Lupus Erythematosus

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