title: Is initial C-reactive protein level associated with corticosteroid use in lupus erythematosus patients during a bacterial infection episode?
abstract: C-reactive protein (CRP), a marker for inflammation, indicates bacterial infection in systemic lupus erythematosus (SLE) when markedly elevated. Our study investigated the association of regular corticosteroid or immunosuppressant use with initial CRP level in febrile SLE patients with bacterial infection.
  
  
  
  This retrospective cohort study included adult SLE patients (18 years of age or older) who presented with fever at the emergency department from January 2008 to December 2012. Data were retrieved from our institutional database.
  
  
  
  CRP levels in the total 193 patient database were significantly increased in the bacterial infection group compared to the no infection and non-bacterial infection groups. Seventy-eight (86.7%) of the 90 patients in the bacterial infection group took regular corticosteroids (mean equivalent dose of prednisolone 0.33±0.26mg/kg/day) and 55 (61.1%) used immunosuppressants. Mean CRP level in the bacterial infection group was 97.8mg/L. CRP level was lower in patients using corticosteroids, but the difference between users and nonusers of corticosteroids was not statistically significant (p=0.367). The difference in CRP level between immunosuppressant and non-immunosuppressant users was also not significant (p=0.599). The Spearman test found no correlation between corticosteroid dosage and CRP level (p=0.911).
  
  
  
  Initial CRP level was not significantly associated with regular corticosteroid or immunosuppressant use in SLEs patients during a bacterial infection episode, and CRP level was not dose-dependently related to daily corticosteroid use. An elevated CRP level might be an appropriate marker for bacterial infection at the emergency department for febrile SLE patients.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Peng-Huei
authors.initials: PH
authors.lastname: Liu
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linko, Taiwan.
authors.forename: Kuang-Hui
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Weng
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Chip-Jin
authors.initials: CJ
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Te-Fa
authors.initials: TF
authors.lastname: Chiu
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan. Electronic address: shouyenchen123@sina.com.
authors.forename: Shou-Yen
authors.initials: SY
authors.lastname: Chen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D015415:Biomarkers / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein
keywords: C-reactive protein lupus erythematous; Fever; Glucocorticoid; Hydroxycorticosteroids; Sepsis