Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Rheumatology and Rehabilitation

Objective: To assess the ability of serum procalcitonin (PCT), high sensitivity C-reactive protein (hsCRP) and Erythrocyte sedimentation rate/hsCRP (ESR/hsCRP rtio) to differentiate between infection and disease activity, as well as to determine the factors associated with infection in SLE patients.Patients and methods: 138 SLE patients were recruited, out of which 131 (94.9%) were females and 7 (5.1%) were males. Patients had a mean age of 28.2 ± 10 years and disease duration of 5.9 ± 5 years. Patients were divided into 2 groups; the 1st consisted of 69 SLE patients with a definable source of infection, whereas the 2nd consisted of 69 SLE patients with no evidence of infection. Comparison of both groups in terms of demographic data, clinical manifestations, disease activity {assessed by SLE disease activity index-2000 score (SLEDAI-2K)} and damage indices {assessed by SLICC/ACR damage index} as well as laboratory investigations and received medications and outcome was done. Measurement of serum PCT as well as plasma hsCRP using ELISA technique was done and ESR/hsCRP ratio was calculated.Results: Pulmonary involvement; lower hemoglobin levels; lower serum albumin; impaired renal function tests; end stage renal disease (ESRD); higher disease damage as well as use of pulse methylprednisolone; oral steroids; cyclophosphamide; mycophenolate mofetil and oral steroid dose were identified as factors associated with infection (p-value <0.05). Thirteen patients in the infection group died and sepsis was the leading cause of death. PCT failed to differentiate between SLE patients with and without infection, did not correlate with severity of infection and was not associated of mortality. Both hsCRP and ESR/hsCRP ratio successfully differentiated between both groups, correlated with systemic inflammatory response syndrome (SIRS) and severity of infection

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