Difference in acute phase response for AIRDs: A cross-sectional multi-centre study based on RA and SLE
Abstract
Aim: To explore the differences in acute phase responses between infection and disease flare and between viral and bacterial infections.
Methods: The retro-prospective, cross-sectional, multi-center study considered subjects who had undergone treatment for infection or disease flare between 2019 to 2021. The patients fulfilling the ACR/EULAR 2010 criteria and 2019 EULAR/ACR criteria for RA and SLE respectively, were recruited from three centers. Patients who did not have autoimmune rheumatic disease or other immune-mediated diseases were considered as controls. The participants were classified into subgroups namely ‘overall’, ‘without autoimmune rheumatic disease’, ‘SLE’ and ‘RA’. The infectious and non-infectious groups, and the bacterial and viral disease groups were compared to evaluate the differences in the parameters namely age, gender, total leucocyte count (TLC), neutrophil count(N), lymphocytes count (L) NLR, CRP and procalcitonin. Student t-test was used for the evaluation of continuous data and chi-square test for categorical data. ROC curves were plotted. The cutoff points of variable at 80% and 90% sensitivity and specificity were estimated for each subgroup to differentiate infection and no-infection.
Results: The data of 439 subjects were considered for the analysis of infection vs. non-infection, and that of 218 patients out of 282 in the infection categories for the viral vs. bacterial analysis. Comparison between infection and non-infection groups demonstrated that the parameters TLC, neutrophil, NLR, CRP and procalcitonin were significantly higher in the infection group; whereas, lymphocytes were significantly lower in the infection group. The overall comparison between viral vs. bacterial groups demonstrated significant differences in TLC, lymphocytes and procalcitonin. The receiver operating characteristic (ROC) curve analyses demonstrated that CRP serves as a better indicator than remaining parameters. However, for the RA subgroup, none of the parameters were significant to differentiate infection and flare. Whereas in SLE, the CRP and NLR were able to distinguish infection. The cut-off values for CRP, NLR, TC and procalcitonin at targeted sensitivity and specificity of 90% and 80% varied across the different sub-groups.
Conclusion: TLC, NLR, CRP, and procalcitonin are beneficial in differentiating infections from non-infection in patients without autoimmune disease. CRP is a better indicator of infection in SLE and normal subjects. CRP and procalcitonin in overall group. However, in the presence of inflammatory autoimmune rheumatic diseases, it is paramount to consider the base elevation of these parameters and the skewed inflammatory response while interpreting the parameters.
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