The role of MBL, PCT, CRP, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio in differentiating infections from flares in lupus

Balaji Musunuri; Rina Tripathy; Sunali Padhi; Aditya K Panda; Bidyut K Das

doi:10.1007/s10067-022-06285-x

The role of MBL, PCT, CRP, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio in differentiating infections from flares in lupus

Clin Rheumatol. 2022 Nov;41(11):3337-3344. doi: 10.1007/s10067-022-06285-x. Epub 2022 Jul 14.

Authors

Balaji Musunuri^#^{1

2}, Rina Tripathy^#³, Sunali Padhi⁴, Aditya K Panda⁵, Bidyut K Das⁶

Affiliations

¹ Department of Medicine, S.C.B. Medical College, Cuttack, 753007, Odisha, India.
² Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
³ Department of Biochemistry, SVP Post-Graduate Institute of Pediatrics, Cuttack, Odisha, India.
⁴ Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India, 760007.
⁵ Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India, 760007. adityarmrc@gmail.com.
⁶ Department of Medicine, S.C.B. Medical College, Cuttack, 753007, Odisha, India. bidyutdas@hotmail.com.

^# Contributed equally.

PMID: 35835900
DOI: 10.1007/s10067-022-06285-x

Abstract

Background: The distinction between infection and flare in systemic lupus erythematosus (SLE) has always been a dilemma for clinicians as the clinical and biochemical profiles overlap. The present study evaluated affordable biomarkers to distinguish infection from flare in an SLE cohort in a tertiary care center in eastern India.

Methods: One hundred and fifty-two SLE patients were clinically evaluated and enrolled in the present study. Hematological, immunological, and biochemical profiles and various biomarkers such as C reactive protein (CRP), procalcitonin (PCT), and Mannose-binding lectin (MBL) were quantified.

Results: One hundred and fifty-two patients (152) were enrolled in the present study and all had SLEDAI scores of more than 4. From which 70 had infection, and the common infections were urinary tract infection (34.28%) followed by pneumonia (27.14%). Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) were significantly elevated in SLE with infections (NLR: 5.84 ± 2.47; CRP: 30.56 ± 41.63) than those with flare (NLR: 3.87 ± 2.62; CRP: 8.73 ± 9.53). The receiver operating characteristic curve (ROC) analysis revealed CRP, PLR, and NLR as important markers for predicting infections (CRP: AUC = 0.682, p = 0.0001; PLR: AUC = 0.668, p = 0.0008; NLR: AUC = 0.742, p < 0.0001). The MBL and PCT levels were comparable among SLE flare and those with infections.

Conclusions: NLR and CRP levels are affordable biomarkers to distinguish infections from flares in SLE. MBL and PCT could not differentiate flare from an infection. Key Points • Biomarkers for the differentiation of infection and flare in SLE are limited. • NLR, PLR, and CRP are promising biomarkers to enable differentiation. • PCT and MBL are not ideal biomarkers to differentiate infection from flare.

Keywords: Biomarkers; C reactive protein; Flare; Infection; Mannose-binding lectin; Neutrophil–lymphocyte ratio; PCT; Systemic lupus erythematosus.

MeSH terms

Biomarkers
C-Reactive Protein / analysis
Humans
Lupus Erythematosus, Systemic* / diagnosis
Lymphocytes / chemistry
Neutrophils* / metabolism
Procalcitonin
Retrospective Studies

Substances

Biomarkers
Procalcitonin
C-Reactive Protein