Ferritin to Erythrocyte Sedimentation Rate Ratio: Simple Measure to Identify Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis
Ferritin to Erythrocyte Sedimentation Rate Ratio: Simple Measure to Identify Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis
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DOI：
10.1002/acr2.11048
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发表时间：
2019-08-01
影响因子：
3.4
通讯作者：
Cron, Randy Q.
中科院分区：
文献类型：
--
作者：
Eloseily, Esraa M. A.;Minoia, Francesca;Cron, Randy Q.
目的巨噬细胞活化综合征（MAS）是系统性幼年特发性关节炎（sJIA）的一种危及生命的并发症。早期诊断至关重要。 sJIA 中 MAS 的分类标准在细胞因子导向治疗中表现较差。本文的目标是探索血清铁蛋白与红细胞沉降率 (ESR) 的简单比率，用于诊断 sJIA 中的 MAS，并评估单独铁蛋白作为识别多种病因 MAS 的筛查工具。 方法 对来自患有和不患有 MAS 的 sJIA 患者以及患有全身性感染 (SI) 的住院患者的大型国际队列数据进行评估，评估铁蛋白：ESR 比率和单独铁蛋白，以识别患有或不患有 MAS 的 sJIA 患者。 sJIA 患者中的 MAS。此外，还探讨了与多种病因相关的较小规模 MAS 患者和发热住院对照的数据。对于队列和对照组，构建了铁蛋白：ESR 比率和单独铁蛋白的受试者工作特征曲线（ROC），并计算了曲线下面积（AUC）。使用 Youden 指数来确定最佳铁蛋白：ESR 比值和单独铁蛋白诊断切点。结果 与无 MAS 的活动性 sJIA 相比，21.5 的铁蛋白：ESR 比值对于诊断 sJIA-MAS 的敏感性为 82%，特异性为 78%。单独使用铁蛋白（筛查工具）的灵敏度为 95%（筛查工具），其识别全因 MAS 与发热住院儿童的特异性为 89.3%。 结论 铁蛋白：ESR 比值是诊断 sJIA 患者 MAS 的实用工具，单独使用血清铁蛋白是识别发热住院儿童 MAS 的出色筛查工具。
ObjectiveMacrophage activation syndrome (MAS) is a life-threatening complication of systemic juvenile idiopathic arthritis (sJIA). Early diagnosis is critical. Classification criteria for MAS in sJIA perform less well in the setting of cytokine-directed therapies. The goal herein was to explore a simple ratio of serum ferritin to the erythrocyte sedimentation rate (ESR) for diagnosis of MAS in the setting of sJIA, and to assess ferritin alone as a screening tool for identifying MAS of multiple etiologies.MethodsData from a large international cohort of sJIA patients with and without MAS, and from hospitalized patients with systemic infection (SI), were assessed for the ferritin:ESR ratio and ferritin alone to identify MAS among sJIA patients. Moreover, data from a smaller cohort of MAS patients associated with multiple etiologies and febrile hospitalized controls were explored. For both cohorts and controls, receiver operating characteristic curves (ROCs) for the ferritin:ESR ratio and ferritin alone were constructed, and areas under the curves (AUCs) were calculated. The Youden index was used to determine the optimal ferritin:ESR ratio and ferritin alone cut points for diagnosis.ResultsA ferritin:ESR ratio of 21.5 was 82% sensitive and 78% specific for diagnosing sJIA-MAS versus active sJIA without MAS. Ferritin alone with a set sensitivity of 95% (screening tool) had an 89.3% specificity of identifying all-cause MAS versus febrile hospitalized children.ConclusionThe ferritin:ESR ratio is a practical tool for diagnosing MAS among sJIA patients, and serum ferritin alone is a remarkable screening tool for identifying MAS among febrile hospitalized children.