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. 2025 Apr 8;23(1):39.
doi: 10.1186/s12969-025-01088-1.

Bacterial infection in patients with juvenile systemic lupus erythematosus and fever

José Fernando Gómez-Urrego  1   2   3   4 , Nathalie Yepes-Madrid  5   6   7 , Mónica Alexandra Gil-Artunduaga  5   6   7 , María Del Pilar Gómez-Mora  5   8   9   7 , Luis Fernando Mejía-Rivera  5   8   10   7 , Robinson Pacheco-López  5   7 , Juan Pablo Rojas-Hernández  5   6   7
Affiliations

Bacterial infection in patients with juvenile systemic lupus erythematosus and fever

José Fernando Gómez-Urrego et al. Pediatr Rheumatol Online J. .

Abstract

Background: Juvenile Systemic Lupus Erythematosus (JSLE) is a chronic, systemic autoimmune disease characterized by an increased susceptibility to infections. Fever in these patients can result from infection, heightened lupus activity, or a combination of both. Various clinical factors and biomarkers have been proposed to differentiate between infection and disease activity, but the results remain inconclusive. The Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2 k) is used to assess lupus activity in the presence or absence of infection. This study aimed to identify factors associated with bacterial infections in JSLE patients presenting with fever.

Methods: A case-control study, approved by the institutional ethics committee, was conducted.

Results: Bacterial infection was identified in 17% of 116 patients. Factors evaluated included immunomodulator use, high-dose steroids, renal replacement therapy, erythrocyte sedimentation rate (ESR) > 20, C-reactive protein (CRP) > 60 and > 90 mg/L, ferritin > 500 ng/mL, neutrophil-to-lymphocyte ratio (NLR) > 6, platelet-to-lymphocyte ratio (PLR) > 133, procalcitonin (PCT) > 0.9 ng/mL, lymphocyte-to-C4 ratio (LC4R) > 66.7, and ESR/CRP ratio < 2. In the adjusted model, PCT > 0.9 ng/mL retained significance with p < 0.01. Nagelkerke's R2 was 0.65, and the Hosmer-Lemeshow test indicated good internal validity.

Conclusions: Bacterial infection was detected in 17% of JSLE patients with fever. Procalcitonin > 0.9 ng/mL is a critical marker for identifying bacterial infection. NLR, PLR, ESR/CRP ratio, LC4R, and ferritin require further investigation to establish definitive cut-off values for differentiating bacterial infections from other infections or disease activity. Individual patient evaluation remains the recommended approach for diagnosis.

Keywords: Bacteria; Biomarkers; Fever; Systemic lupus erythematosus.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Approved by Fundación Clínica Infantil Club Noel Ethical Committee for Research, and Bioethical and Ethical Committee for Research at Universidad Libre, Sectional Cali. Consent for publication: Not applied for this study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection for the study
See this image and copyright information in PMC

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