Serum Procalcitonin for Differentiating Bacterial Infection from Disease Flares in Patients with Systemic Lupus Erythematosus

Serum Procalcitonin for Differentiating Bacterial Infection from Disease Flares in Patients with Systemic Lupus ErythematosusEvie Rosa Widyawanti NEvidence Based Case ReportINTRODUCTIONSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with clinical features of multi-system damages and infection is one of the major causes of death.Increased risk of infection due to intrinsic disturbances of immune responses and the use of immunosuppressive drugs.Infections may mimic exacerbations of SLE, leading to confusion over the diagnosis and appropriate treatment. A reliable biomarker that provides high sensitivity and specificity for the early discrimination of bacterial infection from disease flare in patients with autoimmune diseases was needed.

Clinical scenarioClinical questionCan procalcitonin be uses to differentiate bacterial infection and disease flare on patient with systemic lupus erythematosus?methodsPUBMED0 articles12 articlesProcalcitonin AND Infection AND (Systemic Lupus Erythematosus OR SLE Flare) COCHRANE3 articlesLimited articles within 2004-2014 only.Review articles and those that were not specific for SLE were excludedCritical appraisal

VariableWei Li Ho et alKM Bador et alJinquan Yu et alSensitivity and SpecifitySens: 89,5%Spec: 100%I. Sens SLE : 80%Spec SLE : 78%II. Sens SLE Flare : 83%Spec SLE : 71%Sens : 74,5%Spec: 95,5%Likelihood Ratio(+) = ~(-) = 0,1(+) = 3,6/(-) 0,2(+)= 2,8/(-) 0,2(+)= 16,5(-)= 0,2IMPORTANCEVariableWei Li Ho et alKM Bador et alJinquan Yu et alParticipants49 SLE with febrile30 SLE flare without infection 19 SLE with bacterial infection68 SLE 6 infected with SLE flare4 infected SLE without flare24 non infected with SLE flare34 non infected SLE without flare114 SLE flare patients 47 with bacterial infection67 without infectionStudy DesignRetrospective studyCross sectional studyRetrospective studyHo W-L, Lan J-L, Chen D-Y, Chen Y-H, Huang W-N, Hsieh T-Y. Procalcitonin may be a potential biomarker for distinguishing bacterial infection from disease activity in febrile patients with systemic lupus erythematosus. Formosan Journal of Rheumatology. 2009; 23: 528.Bador KM , Intan S, Hussin S, Gafor AH . Serum procalcitonin has negative predictive value for bacterial infection in active systemic lupus erythematosus. Lupus. 2012; 21(11): 1172 7.Jinquan Y, Bingling X, Huang Y et al. Serum Procalcitonin and C-reactive protein for differentiating bacterial infection from disease activity in patients with systemic lupus erythematosus. Mod Rheumatol. 2014; 24(3): 457-63. VariableWei Li Ho et alKM Bador et alJinquan Yu et alExclusion CriteriaNot availableAlready on antibioticsHad acute myocardial infarction,acute pancreatitis, thyroid or bronchial carcinoma or a < 7 days history of severe trauma or surgeryWith no activity (SLEDAI score = 0)With non bacterial infection (viral and/or fungal infection) or mycobacterium tuberculosis infectionInterventionPCT level was measuredPCT level was measuredPCT was measuredVariableWei Li Ho et alKM Bador et alJinquan Yu et alComparisonPositive cultures in SLE patients with infectionPositive result from blood culture, urine, stool or other specimens in SLE patients with infectionPositive culture of the blood, urine and sputumOutcomePCT level in SLE patients with and without infectionSensitivity and specificity of PCTPCT level in SLE flare with and without infectionPCT level in SLE with and without infectionSensitivity and specificity of PCTPositive predictive valueNegative predictive valuePCT level in SLE flare with and without infectionSensitivity and specificity of PCTPositive predictive valueNegative predictive valueresult

Wei Li Ho et al studyLevels of serum PCT in the bacterial infection group (median 7.11 ng/mL, IQR 1.38-42.83) were higher when compared to the SLE disease flare group (median 0.06 ng/mL, IQR 0.05-0.20, p