Clinical Rheumatology

, Volume 38, Issue 4, pp 997–1005 | Cite as

Utility of neutrophil CD64 and serum TREM-1 in distinguishing bacterial infection from disease flare in SLE and ANCA-associated vasculitis

  • Sajal Ajmani
  • Harshit Singh
  • Saurabh Chaturvedi
  • Ravi Mishra
  • Mohit Kumar Rai
  • Avinash Jain
  • Durga Prasanna Misra
  • Vikas AgarwalEmail author
Original Article


Bacterial and opportunistic infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis owing to treatment with immunosuppressants. Commonly used laboratory tests are unreliable in differentiating infection from active disease patients. Fc receptor (FcγR1 or CD64) expression on neutrophils and soluble TREM-1 (triggering receptor expressed on monocytes) are potential biomarkers of bacterial infections. Our aim was to measure the clinical usefulness of quantitative CD64 measurement on neutrophils and soluble TREM-1 measurements in differentiating bacterial infection from active disease in patients with SLE and ANCA vasculitis. Patients with bacterial infection (n = 25), active disease (n = 51), and healthy controls (n = 20) were included. Neutrophil CD64 expression using flow cytometry and sTREM-1 and procalcitonin levels by ELISA were studied. The percentage of neutrophils with CD64 expression and their mean fluorescence intensity in patients with infection (68.8 (56.9–86.5)%, 1037 (229–1828)) were significantly (p < 0.05) higher as compared to those without infection (7.7 (2.6–13.1)%, 456 (20–968)) and controls (7.05 (1.4–9.5)%, 99.5 (54.7–140.7)). The sensitivity and specificity of CD64 expression on neutrophils to diagnose bacterial infection (using a cutoff value of 30%) was 85% and 84%, respectively, whereas the sensitivity and specificity of procalcitonin was 75% and 85%, respectively. There was no significant difference in soluble TREM-1 levels between the two groups. Quantitative measurement of CD64 on neutrophils can distinguish between systemic infection and the flare of autoimmune diseases.


AAV ANCA-associated vasculitis Biomarker CD64 Sepsis SLE 



ANCA-associated vascuilitis


Anti-neutrophil-associated cytoplasmic antibody


Enzyme-linked immunosorbent assay


Erythrocyte sedimentation rate


Macrophage activation syndrome


Mean fluorescence intensity


Phosphate-buffered saline


Polymorphonuclear leukocytes


Rheumatoid arthritis


Systemic lupus erythematosus


Triggering receptor expressed on monocytes



All the authors have no sources of support to acknowledge.

Funding information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards



Ethical approval

The pertinent ethical committee has given its approval and/or the reported investigations have been performed in accordance with the principles of the Declaration of Helsinki.

Informed consent

Informed consent had been obtained from the patients, whenever appropriate.

Supplementary material

10067_2018_4334_MOESM1_ESM.docx (13 kb)
Supplementary Table 1 (DOCX 13 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Sajal Ajmani
    • 1
  • Harshit Singh
    • 1
  • Saurabh Chaturvedi
    • 1
  • Ravi Mishra
    • 1
  • Mohit Kumar Rai
    • 1
  • Avinash Jain
    • 1
  • Durga Prasanna Misra
    • 1
  • Vikas Agarwal
    • 1
    Email author
  1. 1.Department of Clinical ImmunologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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