Serum Procalcitonin and Presepsin Levels in Patients with Generalized Pustular Psoriasis

Abstract

Patients with generalized pustular psoriasis (GPP) often present with symptoms that must be differentiated from sepsis. Procalcitonin (PCT) and presepsin (P-SEP) are widely used as biomarkers for sepsis; therefore, we examined the serum PCT and P-SEP levels in patients with psoriatic diseases. The enrolled patients included 27 with psoriasis vulgaris (PV) (22 males, 5 females; mean age 47.7 years), 12 with psoriatic arthritis (PsA) (8 males, 4 females; mean age 51.3 years), and 15 with GPP (10 males, 5 females; mean age 63.7 years). The mean serum PCT levels in patients with PV, PsA, and GPP were 0.01 ng/mL (25th-75th percentile; 0.00-0.03), 0.013 ng/mL (0.00-0.03), and 0.12 ng/mL (0.05-0.18), respectively; the levels of PCT were higher for patients with GPP than with PV or PsA but were lower than the PCT cutoff value (0.5 ng/mL) for the diagnosis of infection. The mean serum P-SEP levels in patients with PV, PsA, and GPP were 144.9 pg/mL (25th-75th percentile; 78-181), 168.1 pg/mL (124-203), and 479.9 pg/mL (216-581), respectively. Unexpectedly, the levels of P-SEP in the patients with GPP were as high as the P-SEP cutoff value (317 to 647 pg/mL) used for the diagnosis of infection. We also found that neutrophils produced P-SEP, suggesting that the high serum P-SEP levels in patients with GPP might arise at least in part due to the P-SEP derived from neutrophils activated in GPP. Both serum PCT and P-SEP might therefore be useful as novel serum biomarkers for GPP because their levels were decreased by GPP treatments. However, the measurement of PCT might be more useful than the measurement of P-SEP for discriminating between GPP and sepsis.

Figure 1

Serum procalcitonin (PCT) levels in the study patients with generalized pustular psoriasis (GPP), showing the serum PCT levels in patients with psoriasis vulgaris (PV), psoriatic arthritis (PsA), and GPP at the first visit. Values are expressed as means (horizontal lines) and standard deviations (top and bottom bars). Note that the PCT concentrations are typically below 0.05 ng/mL in healthy people, and a cutoff value of 0.5 ng/mL is widely used for an appropriate indicator of infection. Tukey's multiple comparison test, ^∗p < 0.001.

Figure 2

Serum presepsin (P-SEP) levels in patients with psoriasis vulgaris (PV), psoriatic arthritis (PsA), and generalized pustular psoriasis (GPP) at the first visit. Values are expressed as means (horizontal lines) and standard deviations (top and bottom bars). Note that P-SEP concentrations are typically below 314 pg/mL in healthy people, and a cutoff value of 500 pg/mL is widely used for an appropriate indicator of infection. Tukey's multiple comparison test, ^∗p < 0.001.

Figure 3

Correlations of serum procalcitonin (PCT), presepsin (P-SEP), and C-reactive protein (CRP). Correlations between serum PCT and P-SEP (a), between PCT and CRP (b), and between PCT and CRP (c).

Figure 4

The high serum procalcitonin (PCT) and presepsin (P-SEP) levels in patients with generalized pustular psoriasis (GPP) were significantly decreased after treatment. The serum PCT and P-SEP levels before and after the treatment in 15 patients with GPP are shown. Wilcoxon matched-pairs signed-rank test, ^∗p < 0.001. Characteristics of patients are described in Table 2.

Figure 5

Neutrophils produce presepsin (P-SEP). Monocytes or neutrophils from healthy volunteers were cultured with (E. coli) or without (RPMI) pHrodo E. coli particles, and the concentrations of P-SEP in the culture media were measured. Values are expressed as means (column graph) and standard deviations (top and bottom bars), n = 3. ^∗p < 0.05 (two-tailed unpaired t-test). Data are representative of at least two independent experiments.