THU0442 Serum Prepsepsin (Soluble CD14-Subtype) as a Novel Useful Biomaker for Infection in Patients with Rheumatoid Arthritis (RA)
Authors: S. Tsuji, S. Ohshima, A. Yura, M. Katayama, A. Watanabe, S. Teshigawara, M. Yoshimura, E. Tanaka, Y. Harada, Y. Katada, M. Matsushita, A. Taura, A. Kitatoube, G. Takahashi, S. Endo, J. Hashimoto, Y. Saeki
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> 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. <h3>Objectives</h3> To evaluate the use of presepsin in RA patients during an infectious event. <h3>Methods</h3> 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. <h3>Results</h3> 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&lt;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&lt;0.01) and PCT (r=0.48, p&lt;0.05). In fRA, presepsin level did not correlate with CRP or DAS28-CRP. After treatment, levels of prepsin (p&lt;0.001), CRP (p&lt;0.001), and PCT (p&lt;0.001) were significant decreased in iRA. On the other hand, in fRA, CRP (p&lt;0.001) and DAS28-CRP (p&lt;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&lt;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. <h3>Conclusions</h3> Presepsin is an effective diagnostic marker for infection in RA patients. <h3>References</h3> Y. Yaegashi, et al., J Infect Chemother 2005;11:234-238 T. Shozushima, et al., J Infect Chemother 2011;17:764-769 <h3>Disclosure of Interest</h3> None Declared