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Evaluation of serum presepsin, procalcitonin, copeptin, and high-sensitivity C-reactive protein for differentiating bacterial infection from disease activity in Egyptian patients with systemic lupus erythematosus

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Abstract

Objectives

Several biological markers have been studied for the differentiation of infection from disease activity in systemic lupus erythematosus (SLE) patients with discrepant results. We aimed to evaluate the role of serum presepsin, hs-CRP, procalcitonin (PCT), and copeptin (CPP) in differentiating bacterial infections from disease activity in SLE patients.

Methods

This study is a cross-sectional observational study in which 94 Egyptian patients were recruited from June 2017 to January 2018. Our patients were divided into two groups: group (1) included 48 patients with active SLE hospitalized with any sort of lupus activity and group (2) included 46 patients with active SLE admitted with a proven bacterial infection. Hs-CRP, presepsin, PCT, and CPP were measured using enzyme-linked immune sorbent assay technique.

Results

Hs-CRP, presepsin, PCT, and CPP were highly significantly higher among group (2) patients compared to group (1) patients (p < 0.001). Serum presepsin expressed higher specificity than hs-CRP (87.5% vs 60.4%) but the same sensitivity (80.4%) in the detection of bacterial infection in SLE patients. Serum PCT expressed higher specificity than hs-CRP (100% vs 60.4%) but lower sensitivity (73.9% vs 80.4%). Serum CPP expressed higher specificity than hs-CRP (65.9% vs 60.4%) but lower sensitivity (65.9% vs 80.4%).

Conclusion

Our study suggests that increased serum levels of hs-CRP, presepsin and PCT levels are useful in differentiating bacterial infections from disease activity in SLE patients. Serum CPP could be used as an adjunct with more specific inflammatory biomarkers in making better diagnostic judgments.

Key Points:

• The increased serum levels of hs-CRP, presepsin and PCT levels are useful in differentiating bacterial infections from disease activity in SLE patients.

• Serum Presepsin expressed higher specificity than hs-CRP but the same sensitivity in the detection of bacterial infection in SLE patients.

• Serum CPP expressed higher specificity than hs-CRP but lower sensitivity.

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Authors and Affiliations

  1. Endocrinology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Ula M. AlJarhi

  2. Nephrology unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Khaled Marzouk Sadek, Sanaa A. Khalil & Ahmed Fayed

  3. Rheumatology & Clinical Immunology unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Enas M. Darwish

  4. Infectious Diseases Unit, Internal Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Riem M. Elmessiery & Khaled Salem

  5. Gastroenterology and endoscopy unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Sayed M. Seif El Nasr

  6. Endocrinology Unit, Internal Medicine Department, Beni-suef University, Beni Suef, Egypt

    Mahmoud F. Kamel

  7. Chemical Pathology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

    Dina Hesham

  8. Cairo University Hospitals, Al-Saray St., El-Maniel, Cairo, 11562, Egypt

    Ahmed Fayed

Authors
  1. Ula M. AlJarhi
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  2. Khaled Marzouk Sadek
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Contributions

All authors have contributed significantly and equally in design of this work, data acquisition, analysis and interpretation. In addition to the writing and revising of this manuscript, all authors approved the final version before submission.

Corresponding author

Correspondence to Ahmed Fayed.

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None.

Ethical committee approval

The local ethical committee of the Internal Medicine department, School of Medicine, Cairo University, approved this work.

Human and animal rights

All procedures performed in this study involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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“Informed consent was obtained from all individual participants included in the study”.

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AlJarhi, U.M., Sadek, K.M., Darwish, E.M. et al. Evaluation of serum presepsin, procalcitonin, copeptin, and high-sensitivity C-reactive protein for differentiating bacterial infection from disease activity in Egyptian patients with systemic lupus erythematosus. Clin Rheumatol 40, 1861–1869 (2021). https://doi.org/10.1007/s10067-020-05471-z

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