THU0442 Serum Prepsepsin (Soluble CD14-Subtype) as a Novel Useful Biomaker for Infection in Patients with Rheumatoid Arthritis (RA). (23rd January 2014)

• Record Type: Journal Article
• Authors: Tsuji, S.; Ohshima, S.; Yura, A.; Katayama, M.; Watanabe, A.; Teshigawara, S.; Yoshimura, M.; Tanaka, E.; Harada, Y.; Katada, Y.; Matsushita, M.; Taura, A.; Kitatoube, A.; Takahashi, G.; Endo, S.; Hashimoto, J.; Saeki, Y.
• Is Part Of: Annals of the rheumatic diseases. Volume 72:Supplement 3(2013)
• Page Start: A314
• Page End: A314
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-eular.970
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Infection is one of the serious complications seen in the management of RA patients. The acute inflammatory marker C-reactive protein (CRP) is elevated both during infection and during high disease activity of RA, and this often poses a problem when distinguishing the two. The soluble CD14 subtype, presepsin has been reported to be a novel effective marker for the diagnosis of sepsis but has not been evaluated in RA patients. Objectives: To evaluate the use of presepsin in RA patients during an infectious event. Methods: 25 RA patients with infections, 21 RA patients with high disease activity, 23 healthy controls (HC) were enrolled in this study. RA patients in whom the pathogens were identified (22 bacterias, 2 viruses, and 1 M. tuberculosis) were designated as the infection RA group (iRA), high disease activity RA patients without infection were designated as the flare RA group (fRA). Presepsin was measured using a chemiluminescent enzyme immunoassay. CRP and procalcitonin (PCT) were also measured. RA disease activity was evaluated using DAS28-CRP. Levels of respective measurements at both pre- and post-treatment were analyzed using the Wilcoxon signed-rank test, and comparisons of levels within each group were analyzed using the Mann-Whitney's U-test. Additionally, Spearman's rank correlation coefficient was used to analyze the correlation of levels of presepsin, CRP, and PCT in iRA and correlation of presepsin, DAS28-CRP, and CRP in fRA. Further, AUC was obtained from the ROC analysis. Treatment for iRA included antibiotics, antivirals, and treatment for fRA included corticosteroids, DMARDs, and biologics. Results: In fRA, average level of CRP was 2.4±2.1mg/dl, DAS28-CRP was 4.2±1.31. At pre-treatment, levels of presepsin in iRA (2088.4±4243.7pg/ml) was significantly higher compared to in fRA (319.3±321.8pg/ml, p<0.01). Both levels were significantly higher compared to those in HC (136±57.0pg/ml). In iRA, presepsin level correlated with CRP (r=0.65, p<0.01) and PCT (r=0.48, p<0.05). In fRA, presepsin level did not correlate with CRP or DAS28-CRP. After treatment, levels of prepsin (p<0.001), CRP (p<0.001), and PCT (p<0.001) were significant decreased in iRA. On the other hand, in fRA, CRP (p<0.001) and DAS28-CRP (p<0.001) were significantly decreased after treatment, however presepsin level showed no significant change (p=0.37). Furthermore, presepsin levels in fRA with low disase activity after treatment were significantly higher compared to those in HC (p<0.01). ROC analysis of iRA showed that AUC levels for presepsin was 0.817, indicating the efficacy of presepsin for diagnosis of infection in RA. Conclusions: Presepsin is an effective diagnostic marker for infection in RA patients. References: Y. Yaegashi, et al., J Infect Chemother 2005;11:234-238 T. Shozushima, et al., J Infect Chemother 2011;17:764-769 Disclosure of Interest: None Declared