Serum procalcitonin and C-reactive protein for differentiating bacterial infection from disease activity in patients with systemic lupus erythematosus

Abstract

Objective. To study the clinical value of procalcitonin (PCT) and C-reactive protein (CRP) in differentiating bacterial infection from disease activity in systemic lupus erythematosus (SLE) patients.

Method. PCT and CRP in active SLE patients complicated with and without bacterial infection were retrospectively studied. Bacterial infection was diagnosed by positive culture results or typical symptoms and signs combined with positive response to antibiotics. Disease activity of SLE was assessed by systemic lupus erythematosus disease activity index (SLEDAI).

Result. One hundred and fourteen active SLE patients were recruited, 47 of which were with bacterial infection and 67 were non-infected. PCT and CRP levels were significantly elevated in patients with bacterial infection (P < 0.05). The ideal cutoff value for PCT was 0.38 ng/ml, at which the sensitivity (74.5%) and specificity (95.5%) combined the best. The negative predictive value and positive predictive value to detect bacterial infection were 84.2% and 92.1%, respectively. PCT but not the CRP level in the septic patients was significantly higher than that of non-septic ones. Meanwhile, in patients with SLEDAI score of > 10, both PCT and CRP levels were higher in patients with bacterial infection, but the difference was only statistically significant for PCT (P < 0.05). PCT was significantly reduced after anti-bacterial treatment.

Conclusion. PCT test is superior to CRP test in detecting superimposed bacterial infection in active SLE patients. The levels of PCT are correlated with the severity of bacterial infection and can be used to monitor the response to antibiotic treatment.

Keywords:

• Bacterial infection
• C-reactive protein
• Disease activity
• Procalcitonin
• Systemic lupus erythematosus

Funding

This project was supported by a grant from the National Natural Science Foundation (81273278), grants from the Natural Science Foundation of Guangdong Sciences Committee (s2011010004578 and S2012010008780), and a grant from the Guangzhou Science and Technology program (2012J4100085).

Conflict of interest

None.