Neutrophil Z Is a Novel Marker to Differentiate Disease Flares From Bacterial Infections in Febrile SLE Patients

IF 2.4 4区 医学 Q2 RHEUMATOLOGY
Kishan Majithiya, Komal Singh, Pankti Mehta, Chengappa Kavadichanda, M. S. Gayathri, Deepika Kounassegarane, Ranjan Gupta, Seema Sharma, Able Lawrence, Amita Aggarwal
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Abstract

Aim and Objectives

To assess the role of newer biomarkers like neutrophil Z, myeloid-related protein 8/14 (MRP 8/14), IL-6, sCD14, and neutrophil CD64 (nCD64) to distinguish flare from infection in febrile lupus patients.

Methods

In this prospective multicentric observational study to determine the etiology of fever in febrile lupus patients, in addition to routine tests, serum procalcitonin, neutrophil X, neutrophil Y, and neutrophil Z were done. sCD14, MRP8/14, and IL-6 were done by ELISA. nCD64 expression was measured by flow cytometry. All these biomarkers were assessed individually and in combination to see their ability to distinguish between infection and lupus flare.

Results

Among 159 febrile SLE patients, there were 55 infections, 65 disease flares, 38 flares and infections combined, and 1 malignancy. Patients with bacterial infections had a higher CRP, procalcitonin, neutrophil-to-lymphocyte ratio, Neutrophil Z, sCD14 levels, and neutrophil CD64 expression. While patients with flares had lower C3, C4, and higher anti-DsDNA antibody levels. IL-6 and MRP8/14 levels were similar in both groups. Combination of neut-Z with C3 or anti-dsDNA antibody could discriminate between flare and infection with AUC 0.88 (0.80–0.96) and 0.86 (0.78–0.95). Addition of TLC or procalcitonin or nCD64 MFI to these scores improved them marginally. Though composite scores with CRP and anti-dsDNA/procalcitonin also performed well but these were inferior to neutrophil Z-based composite models. These results were consistent in sensitivity analysis.

Conclusion

Neutrophil Z, complement C3, anti-dsDNA antibody levels, and TLC or procalcitonin-based composite score are good tools to differentiate between infection and flare in a febrile lupus patient. Serum MRP 8/14, IL-6, sCD14, and nCD64 did not perform well. Simple biomarkers such as neut-Z should be investigated further in SLE.

中性粒细胞Z是一种区分发热SLE患者疾病耀斑与细菌感染的新标志物
目的和目的评估中性粒细胞Z、骨髓相关蛋白8/14 (MRP 8/14)、IL-6、sCD14和中性粒细胞CD64 (nCD64)等新生物标志物在发热狼疮患者中区分急性发作和感染的作用。方法本前瞻性多中心观察研究旨在确定发热狼疮患者发热的病因,除常规检查外,还检测血清降钙素原、中性粒细胞X、中性粒细胞Y和中性粒细胞Z。ELISA检测sCD14、MRP8/14、IL-6。流式细胞术检测nCD64的表达。所有这些生物标志物都被单独评估和组合评估,以了解它们区分感染和狼疮发作的能力。结果159例SLE发热患者中,感染55例,并发疾病65例,并发感染38例,恶性肿瘤1例。细菌感染患者CRP、降钙素原、中性粒细胞与淋巴细胞比值、中性粒细胞Z、sCD14水平和中性粒细胞CD64表达均较高。而有耀斑的患者C3、C4较低,抗dsdna抗体水平较高。两组IL-6和MRP8/14水平相似。neut-Z与C3或抗dsdna抗体联合使用,AUC分别为0.88(0.80-0.96)和0.86(0.78-0.95),可区分感染和感染。添加TLC或降钙素原或nCD64 MFI对这些评分有轻微改善。虽然CRP和抗dsdna /降钙素原的复合评分也表现良好,但它们不如中性粒细胞z为基础的复合模型。这些结果在敏感性分析中是一致的。结论中性粒细胞Z、补体C3、抗dsdna抗体水平和TLC或降钙素原复合评分是鉴别发热狼疮患者感染与发作的良好工具。血清MRP 8/14、IL-6、sCD14、nCD64表现不佳。简单的生物标志物,如neut-Z,应该在SLE中进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.70
自引率
4.00%
发文量
362
审稿时长
1 months
期刊介绍: The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.
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