Skleroderma İlişkili İnterstisyel Akciğer Hastalığı ve Bakteriyel Pnömoni’nin Ayırıcı Tanısında Prokalsitonin Düzeylerinin Değerlendirilmesi
Abstract
Objectives: Scleroderma/Systemic Sclerosis (SSc) is characterized by progressive fibrosis. SSc related interstitial lung disease (SSc-ILD) is a major cause of mortality and morbidity among SSc patients. Procalcitonin (PCT) is used for diagnosis and follow up bacterial infections and sepsis. Bacterial pneumonia is an important situation that should be considered in the differential diagnosis of lung diseases. In this study, we aimed to investigate the diagnostic value of serum PCT between in patients with SSc-ILD and bacterial pneumonia.
Materials and Methods: One-hundred and fifty-one SSc patients were retrospectively evaluated. Of these, 27 patients with SSc-ILD whose PCT levels checked, and 18 patients diagnosed with bacterial pneumonia were included to the study.
Results: Twenty-seven (23 female, four male) patients with a mean age of 49.3±13.5 and a mean duration of disease 9.9±5.9 years were evaluated in the SSK-ILD group. There were 17 (two female, 15 male) patients with a mean age of 75.2±14.6 in pneumonia group. PCT level was higher in pneumonia group than in SSK-ILD group (8.1±15 and 0.1±0.4, p<0.001, respectively). PCT level was higher than 0.12 ng/mL in four of SSK-ILD (14.8%) and 15 of pneumonia patients (88.2%) (p<0.001). Similarly, one patient (3.7%) in SSK-İAH group had a PCT level that was higher than 0.5 ng/mL, whereas nine patients (52.9%) in pneumonia group (p<0.001). Receiver operating characteristicanalyses showed good sensitivity and specificity with a 0.16 ng/mL PCT level to predict discrimination between SSc-ILD and pneumonia (AUC=0.96, 95% Confidence interval=0.91-1.0, p<0.001).
Conclusion: This study showed that high serum PCT levels induce infection rather than SSc-ILD and it could be used in differential diagnosis of SSc-ILD and pneumonia.
Keywords
Systemic Sclerosis, Scleroderma, Interstitial Lung Disease, Acute Phase Reactants, Procalcitonin
Ethical Statement
Etik Kurul Onayı: Çalışma için Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (onay no: 17-1110-18).
References
- 1. Varga J. Systemic sclerosis: an update. Bull NYU Hosp Jt Dis. 2008;66:198-202.
- 2. Şendur N, Şendur ÜG. Skleroderma. Türkiye Klinikleri. 2018;15-20.
- 3. Goh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177:1248-1254.
- 4. Mathai SC, Danoff SK. Management of interstitial lung disease associated with connective tissue disease. BMJ. 2016;352:h6819.
- 5. Türktaş H. İnterstisyel Akciğer Hastalıkları ve Patologlara Notlar. Turkiye Klinikleri J Med Pathol-Special Topics. 2018;3:183-188.
- 6. Demirdağ F. Fibrozisle Karakterize İnterstisyel Akciğer Hastalıklarında Ayırıcı Tanı. Turkiye Klinikleri J Med Pathol-Special Topics. 2018;3:167-176.
- 7. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Mater Sociomed. 2013;25:277-281.
- 8. Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34:1996-2003.
- 9. Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:426-435.
- 10. Bilgili B, Haliloğlu M, Aslan MS, et al. Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis. Turk J Anaesthesiol Reanim. 2018;46:38-43.