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.
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T. Shozushima, et al., J Infect Chemother 2011;17:764-769
Disclosure of Interest None Declared