THU0442 Serum Prepsepsin (Soluble CD14-Subtype) as a Novel Useful Biomaker for Infection in Patients with Rheumatoid Arthritis (RA)
Shuhei TsujiShiro OhshimaA. YuraMasao KatayamaA. WatanabeS. TeshigawaraMitsuhiro YoshimuraEriko TanakaYoshinori HaradaYoshinori KatadaM. MatsushitaAkie TauraA. KitatoubeGaku TakahashiSatoshi EndoJun HashimotoYukihiko Saeki
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Abstract:
Background
Infection is one of the serious complications seen in the management of RA patients. The acute inflammatory marker C-reactive protein (CRP) is elevated both during infection and during high disease activity of RA, and this often poses a problem when distinguishing the two. The soluble CD14 subtype, presepsin has been reported to be a novel effective marker for the diagnosis of sepsis but has not been evaluated in RA patients.Objectives
To evaluate the use of presepsin in RA patients during an infectious event.Methods
25 RA patients with infections, 21 RA patients with high disease activity, 23 healthy controls (HC) were enrolled in this study. RA patients in whom the pathogens were identified (22 bacterias, 2 viruses, and 1 M. tuberculosis) were designated as the infection RA group (iRA), high disease activity RA patients without infection were designated as the flare RA group (fRA). Presepsin was measured using a chemiluminescent enzyme immunoassay. CRP and procalcitonin (PCT) were also measured. RA disease activity was evaluated using DAS28-CRP. Levels of respective measurements at both pre- and post-treatment were analyzed using the Wilcoxon signed-rank test, and comparisons of levels within each group were analyzed using the Mann-Whitney's U-test. Additionally, Spearman's rank correlation coefficient was used to analyze the correlation of levels of presepsin, CRP, and PCT in iRA and correlation of presepsin, DAS28-CRP, and CRP in fRA. Further, AUC was obtained from the ROC analysis. Treatment for iRA included antibiotics, antivirals, and treatment for fRA included corticosteroids, DMARDs, and biologics.Results
In fRA, average level of CRP was 2.4±2.1mg/dl, DAS28-CRP was 4.2±1.31. At pre-treatment, levels of presepsin in iRA (2088.4±4243.7pg/ml) was significantly higher compared to in fRA (319.3±321.8pg/ml, p<0.01). Both levels were significantly higher compared to those in HC (136±57.0pg/ml). In iRA, presepsin level correlated with CRP (r=0.65, p<0.01) and PCT (r=0.48, p<0.05). In fRA, presepsin level did not correlate with CRP or DAS28-CRP. After treatment, levels of prepsin (p<0.001), CRP (p<0.001), and PCT (p<0.001) were significant decreased in iRA. On the other hand, in fRA, CRP (p<0.001) and DAS28-CRP (p<0.001) were significantly decreased after treatment, however presepsin level showed no significant change (p=0.37). Furthermore, presepsin levels in fRA with low disase activity after treatment were significantly higher compared to those in HC (p<0.01). ROC analysis of iRA showed that AUC levels for presepsin was 0.817, indicating the efficacy of presepsin for diagnosis of infection in RA.Conclusions
Presepsin is an effective diagnostic marker for infection in RA patients.References
Y. Yaegashi, et al., J Infect Chemother 2005;11:234-238 T. Shozushima, et al., J Infect Chemother 2011;17:764-769Disclosure of Interest
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Procalcitonin and C-reactive-protein are inflammatory markers for sepsis. The authors evaluated their sensitivity and specificity in pediatric patients with cancer and febrile neutropenia.Serum procalcitonin and C-reactive-protein were evaluated. Patients (n = 54) were divided into 2 groups, with severe infection (n = 18) or without documented infection (n = 36).Procalcitonin and C-reactive protein were significantly higher in the high-risk group. Procalcitonin displayed 72.2% sensitivity and 80.5% specificity. C-reactive-protein had a sensitivity of 77.7% and specificity of 77.2%.Procalcitonin is an accurate predictor of bacterial infection in neutropenic children, while C-reactive-protein may be a better screening test in emergency settings.
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Objective To explore the change of serum procalcitonin and C reactive protein and assessing their prognostic value in patients with intracranial infection.Methods Fifty-one patients with intracranial infection from January 2009 to December 2012 in our hospital were selected as the study subjects(the study group),and 34 healthy individuals at the same time were selected as the control group.Procalcitonin and C reactive protein in serum were determined.The 51 patients were divided randomly into the cure group,the improved group and the worse/death group.The relationship between procalcitonin,C reactive protein and prognosis were analyzed.Results Compared with the control group,procalcitonin and C reactive protein in serum were significantly increased in the study group(P0.05).Compared with the worse/death group,procalcitonin and C reactive protein in serum significantly reduced in the cure group and the improved group(P0.05).Procalcitonin and C reactive protein in the cure group significantly reduced than that in the improved group(P0.05).Conclusion Serum procalcitonin and C reactive protein level can be used as auxiliary indexes for clinical diagnosis and prognosis of intracranial infection.
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Objective: To study the serum procalcitonin(PCT) and C-reactive protein(CRP) in infective discases and its clinical significance.Methods:The contents of PCT and CRP in sera of 100 and 40 non-infected cases of newborn were examed.Results:(1)The levels of PCT and CRP in bacteria infected group were significantly higher than that in virus infected and non-infected groups(P0.01).(2)The levels of PCT and CRP in virus infected group were slightly higher than that in non-infected group.There was no significant difference among them(P0.05).(3)In the bacteria infected group,there were significant differences between the pretreament levels of PCT and CRP and past treatment levels of them(P0.01).Conclusion:The examination of serum PCT and CRP is helpful to make distinctive diagnosis for infections at early stage,and the dynamic determination of their level change is valuable for judgement of therapeutic results.
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Procalcitonin (PCT) is an inflammatory marker that has been used as indicator of severe bacterial infection. We evaluated the concentrations of PCT as a marker for systemic infection compared to C-reactive protein (CRP) in patients neutropenic febrile. 52 adult patients were enrolled in the study. Blood sample was collected in order to determine the serum concentrations of PCT, CRP and other hematological parameters at the onset of fever. The patients were divided into 2 groups, one with severe infection (n = 26) and the other in which the patients did not present such an infection (n = 26). Then PCT and CRP concentrations at the fever onset were compared between groups using non parametric statistical tests, ROC curve, sensitivity, specificity, likelihood ratio, and Spearman's correlation coefficient. The mean of PCT was significantly higher in the group with severe infection (6.7 ng/mL versus 0.6 ng/mL – p = 0.0075) comparing with CRP. Serum concentrations of 0.245 ng/mL of PCT displayed 100% de sensitivity and 69.2% specificity. PCT concentrations of 2,145 ng/mL presented a likelihood ratio of 13, which was not observed for any concentration of CRP. PCT seems to be an useful marker for the diagnosis of systemic infection in febrile neutropenic patients, probably better than CRP.
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