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Background <p>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&#xa0;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.</p> Methods <p>A case–control study, approved by the institutional ethics committee, was conducted.</p> Results <p>Bacterial infection was identified in 17% of 116 patients. Factors evaluated included immunomodulator use, high-dose steroids, renal replacement therapy, erythrocyte sedimentation rate (ESR) &gt; 20, C-reactive protein (CRP) &gt; 60 and &gt; 90&#xa0;mg/L, ferritin &gt; 500&#xa0;ng/mL, neutrophil-to-lymphocyte ratio (NLR) &gt; 6, platelet-to-lymphocyte ratio (PLR) &gt; 133, procalcitonin (PCT) &gt; 0.9&#xa0;ng/mL, lymphocyte-to-C4 ratio (LC4R) &gt; 66.7, and ESR/CRP ratio &lt; 2. In the adjusted model, PCT &gt; 0.9&#xa0;ng/mL retained significance with <i>p</i> &lt; 0.01. Nagelkerke’s R<sup>2</sup> was 0.65, and the Hosmer–Lemeshow test indicated good internal validity.</p> Conclusions <p>Bacterial infection was detected in 17% of JSLE patients with fever. Procalcitonin &gt; 0.9&#xa0;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.</p>

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Bacterial infection in patients with juvenile systemic lupus erythematosus and fever

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月8日

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  • 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

摘要

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.