José Fernando Gómez-Urrego, Nathalie Yepes-Madrid, Mónica Alexandra Gil-Artunduaga, María Del Pilar Gómez-Mora, Luis Fernando Mejía-Rivera, Robinson Pacheco-López, Juan Pablo Rojas-Hernández
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This study aimed to identify factors associated with bacterial infections in JSLE patients presenting with fever.</p><p><strong>Methods: </strong>A case-control study, approved by the institutional ethics committee, was conducted.</p><p><strong>Results: </strong>Bacterial infection was identified in 17% of 116 patients. Factors evaluated included immunomodulator use, high-dose steroids, renal replacement therapy, erythrocyte sedimentation rate (ESR) > 20, C-reactive protein (CRP) > 60 and > 90 mg/L, ferritin > 500 ng/mL, neutrophil-to-lymphocyte ratio (NLR) > 6, platelet-to-lymphocyte ratio (PLR) > 133, procalcitonin (PCT) > 0.9 ng/mL, lymphocyte-to-C4 ratio (LC4R) > 66.7, and ESR/CRP ratio < 2. In the adjusted model, PCT > 0.9 ng/mL retained significance with p < 0.01. Nagelkerke's R<sup>2</sup> was 0.65, and the Hosmer-Lemeshow test indicated good internal validity.</p><p><strong>Conclusions: </strong>Bacterial infection was detected in 17% of JSLE patients with fever. Procalcitonin > 0.9 ng/mL is a critical marker for identifying bacterial infection. NLR, PLR, ESR/CRP ratio, LC4R, and ferritin require further investigation to establish definitive cut-off values for differentiating bacterial infections from other infections or disease activity. 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引用次数: 0
摘要
背景:青少年系统性红斑狼疮(JSLE)是一种慢性、全身性自身免疫性疾病,其特征是对感染的易感性增加。这些患者的发热可由感染、狼疮活动加剧或两者共同引起。已经提出了各种临床因素和生物标志物来区分感染和疾病活动,但结果仍然不确定。系统性红斑狼疮疾病活动指数-2000 (sledai - 2k)用于评估存在或不存在感染的狼疮活动。本研究旨在确定以发热为表现的JSLE患者细菌感染的相关因素。方法:采用经机构伦理委员会批准的病例对照研究。结果:116例患者中有17%存在细菌感染。因素评价包括免疫调制剂使用,高剂量类固醇,肾脏替代疗法,红细胞沉降率(ESR) > 20、c反应蛋白(CRP) > 60和90 mg / L >,铁蛋白> 500 ng / mL, neutrophil-to-lymphocyte比率(NLR) > 6, platelet-to-lymphocyte比率(PLR) > 133,原降钙素(PCT) > 0.9 ng / mL, lymphocyte-to-C4比率(LC4R) > 66.7,和ESR、CRP比0.9 ng / mL保留意义2 p为0.65,和Hosmer-Lemeshow测试表明良好的内部效度。结论:17%的JSLE发热患者检出细菌感染。降钙素原> 0.9 ng/mL是鉴别细菌感染的关键标志物。NLR、PLR、ESR/CRP比值、LC4R和铁蛋白需要进一步研究,以确定区分细菌感染与其他感染或疾病活动性的明确临界值。个体患者评估仍然是推荐的诊断方法。
Bacterial infection in patients with juvenile systemic lupus erythematosus and fever.
Background: Juvenile Systemic Lupus Erythematosus (JSLE) is a chronic, systemic autoimmune disease characterized by an increased susceptibility to infections. Fever in these patients can result from infection, heightened lupus activity, or a combination of both. Various clinical factors and biomarkers have been proposed to differentiate between infection and disease activity, but the results remain inconclusive. The Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2 k) is used to assess lupus activity in the presence or absence of infection. This study aimed to identify factors associated with bacterial infections in JSLE patients presenting with fever.
Methods: A case-control study, approved by the institutional ethics committee, was conducted.
Results: Bacterial infection was identified in 17% of 116 patients. Factors evaluated included immunomodulator use, high-dose steroids, renal replacement therapy, erythrocyte sedimentation rate (ESR) > 20, C-reactive protein (CRP) > 60 and > 90 mg/L, ferritin > 500 ng/mL, neutrophil-to-lymphocyte ratio (NLR) > 6, platelet-to-lymphocyte ratio (PLR) > 133, procalcitonin (PCT) > 0.9 ng/mL, lymphocyte-to-C4 ratio (LC4R) > 66.7, and ESR/CRP ratio < 2. In the adjusted model, PCT > 0.9 ng/mL retained significance with p < 0.01. Nagelkerke's R2 was 0.65, and the Hosmer-Lemeshow test indicated good internal validity.
Conclusions: Bacterial infection was detected in 17% of JSLE patients with fever. Procalcitonin > 0.9 ng/mL is a critical marker for identifying bacterial infection. NLR, PLR, ESR/CRP ratio, LC4R, and ferritin require further investigation to establish definitive cut-off values for differentiating bacterial infections from other infections or disease activity. Individual patient evaluation remains the recommended approach for diagnosis.
期刊介绍:
Pediatric Rheumatology is an open access, peer-reviewed, online journal encompassing all aspects of clinical and basic research related to pediatric rheumatology and allied subjects.
The journal’s scope of diseases and syndromes include musculoskeletal pain syndromes, rheumatic fever and post-streptococcal syndromes, juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, local and systemic scleroderma, Kawasaki disease, Henoch-Schonlein purpura and other vasculitides, sarcoidosis, inherited musculoskeletal syndromes, autoinflammatory syndromes, and others.