Inflammatory markers and fever in SLE patients

Introduction:

Infections affect 25–50% of Systemic Lupus Erythrematosis (SLE) patients and are responsible for more than 20% of hospitalizations. A life-threatening infection affects at least 20% of these patients ⁽¹⁾.

The diagnosis of these patients is an important challenge because the initial clinical manifestation of Systemic Lupus Erythrematosis (SLE) is very similar to the acute febrile phase of infection (e.g., sepsis). Infections often require anti-infective treatment and reducing the number or dose of immunosuppressive agents, while the active Systemic Lupus Erythrematosis (SLE) requires enhanced immunosuppressive therapy. Given that treatments to infection and active Systemic Lupus Erythrematosis (SLE) are compl-etely opposite, making the correct early diagnosis is critical for determining the treatment strategy. In recent years, many studies have focused on investigating the biomarker used for distinguishing between infection and disease activity in Systemic Lupus Erythrematosis (SLE) patients, which include C-reactive protein (CRP)⁽²⁾.

The study aimed to evaluate the inflam-matory markers in feverish Systemic Lupus Erythrematosis (SLE) patients

Patients and methods

This study was across sectional case control study. This study was carried out on 20 Systemic Lupus Erythrematosis (SLE) patients fulfilling the 2019 ACR/EULAR 2019 classification criteria⁽³⁾. 20 age and sex matched healthy volunteers were served as control group.

All patients were feverish, diagnosis of infection based on the clinical symptoms and signs of infection. All cases were investigated for Complete Blood Count (CBC), neutrophils, Erythrocyte Sedimen-tation Rate (ESR) and C Reactive Protien (CRP).

 Statistical analysis

Data were coded, entered and analyzed using Statistical program for social science (SPSS version 26). Description of quantitative

variables as mean, standard deviation (SD) and range. Description of qualitative variables as number (no.) and percentage (%). Student's t-test was used to compare the difference between two group means in interval and ordinal variables. Pearson and spearman correlation coefficients (r) were calculated for detection of parametric correlations.

Results

Our results showed that there was a significance difference between infected (group Ι) and non infected (goup II). Systemic Lupus Erythrematosis (SLE) patients regarding the mean value of neutrophils between both groups (p = 0.008), Erythrocyte Sedimentation Rate (ESR) 1st hour between both groups (p = 0.002) and also in the mean and the number of positive C Reactive Protien (CRP) between both groups and in group Ⅱ with (p=0.003 & p=0.002) respectively. Moreover there was significant correlation between inflammatory markers (neutron-phils, Erythrocyte Sedimentation Rate (ESR) 1^sth., C Reactive Protien (CRP) and infection in Systemic Lupus Erythre-matosis (SLE) patients with (p=0.007, p=0.001, p=0.002) respectively.

Discussion

Our study found a significant difference between infected and noninfected systemic lupus erythrematosis (SLE) patients regarding, neutrophils (p=0.008), Erythro-cyte Sedimentation Rate (ESR) (p=0.002) and C Reactive Protien (CRP) (p=0.002). We also found a significant correlation regarding, neutrophils (p= 0.007), Erythro-cyte Sedimentation Rate (ESR) 1^st h (p=0.001) and C Reactive Protien (CRP) (p=0.002) and presence of suggestive clinical symptoms of infection and blood culture.

Our results were in agreement with the studies done by^(5-7) Sciascia et al., (2012), Song et al., (2015), Gao et al. (2016) and Zhang et al., (2017) who found that C Reactive Protien (CRP) was useful biomarker in diagnosis of infection. We didnʼt find significant difference regarding neutrophils, Erythrocytes Sedimentation Rate (ESR) and C Reactive Protien (CRP) between active and inactive Systemic Lupus Erythrematosis (SLE) patients (p>0.05).

In Conclusion

Infection is frequent in Systemic Lupus Erythrematosis (SLE) patients. Neutro-phils, Erythrocytes Sedimentation Rate (ESR) and C Reactive Protien (CRP) could be used as a tool for early diagnosis of infection in patients with Systemic Lupus Erythrematosis (SLE).