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Title: Rendimiento diagnóstico de índices paraclínicos en la diferenciación entre infección y actividad clínica de pacientes con lupus eritematoso sistémico en Medellín, Colombia
Author: Santamaria-Alza, Yeison
Maceira, Marc  
Fernández Martínez, Daniel  
Abstract: INTRODUCTION: Systemic lupus erythematosus is an autoimmune disease with multisystem involvement. In clinical practice, it is important to differentiate if a patient has a relapse of the disease or infection since they have similar manifestations, but the therapeutic approach is different, and the treatment of one can worsen the other. OBJECTIVE: To determine the diagnostic performance of the paraclinical indices in the differentiation of infection and clinical activity of the disease in patients with SLE from Medellín, Colombia. METHODS: Retrospective cohort study that included patients with systemic lupus erythematosus who consulted a referral center in northwestern Colombia between 2012-2019. Descriptive statistics, group comparison, index prediction evaluation, and cluster analysis were performed. R software version 4.0.3 and Stata version 12.0 were used. RESULTS: 246 subjects were included. The median age of the patients included was 28 years, and of these 90.6% corresponded to the female sex. The median duration of the disease was 48 months. The most frequent manifestations found were immunological, hematological and mucocutaneous. Regarding the outcome, 36.9% had relapse, 16.6% had infection, 15.4% had relapse and infection, and 30.8% had neither relapse nor infection. A comparison of the 17 indices was made in the 4 groups of patients and found that the scores were different between the groups. The best performance index for the prediction of infection was lymphocyte / C4 with a ROC curve of 0.75 for a cut-off point of 66.7 with a sensitivity of 60.5% and a specificity of 80.5%, this with an OR of 0.98 that reached statistical significance (p <0.001) and adequate internal validity (Hosmer-Lemeshow 0.06). In the cluster analysis, the first cluster was characterized by lower levels in most of the indices with a higher prevalence of the infection outcome and a lower prevalence of relapse. CONCLUSION: From the multiple indexes evaluated, it was found that those reported in the literature with good discriminative capacity did not perform well in the present study. It was found that the lymphocyte / C4 ratio could differentiate those patients with infection.
Keywords: c-reactive protein
erythrocyte sedimentation rate
platelets lymphocyte neutrophils
Type: info:eu-repo/semantics/masterThesis
Issue Date: 5-Jan-2021
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