University of Basel, Basel, Switzerland.
Division of Clinical Pharmacology and Toxicology and Regional Pharmacovigilance Center, University Hospital Basel, Basel, Switzerland.
Int Arch Allergy Immunol. 2018;176(1):44-54. doi: 10.1159/000487670. Epub 2018 Apr 13.
The spectrum of inflammatory marker response in DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome has not been systematically characterized.
An epidemiological biomarker study of C-reactive protein (CRP) and procalcitonin (PCT) values in patients with DRESS syndrome reported at 2 regional pharmacovigilance centers in Switzerland or published in the medical literature 2008-2016 was performed.
Ninety-four DRESS cases were studied. All cases showed a CRP value > 10 mg/L (the upper limit of normal). The mean CRP value was 109.2 ± 79.4 mg/L. CRP values were significantly higher in 22 cases where a cause of inflammation besides DRESS could not be excluded (mean 162.1 vs. 92.9 mg/L; p = 0.003). Receiver operator characteristics curve analysis showed a moderate performance with a CRP cut-off value of 99.4 mg/L (AUC 0.717) to distinguish between patients with and without a possible additional cause of inflammation. The mean and median PCT values were 2.44 ± 5.94 and 0.69 ng/mL, respectively (n = 25 patients). Patients in whom an additional cause of inflammation besides DRESS could not be excluded showed a median PCT of 1.37 ng/mL (n = 9) versus 0.67 ng/mL (n = 16) in patients with DRESS only. PCT values were above the normal cut-off of 0.1 ng/mL, suggestive of bacterial infection in all but 1 case. Furthermore, there was a correlation between PCT values and hepatic enzyme measurements.
Evaluating CRP and PCT values might be of use in helping physicians to distinguish between cases of DRESS syndrome with and without concurrent infection or other causes of inflammation. Further prospective investigation is required to define the use of these inflammatory markers in the management of DRESS.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征的炎症标志物反应谱尚未得到系统描述。
对瑞士 2 个区域药物警戒中心报告或 2008 年至 2016 年医学文献中发表的 DRESS 综合征患者的 C 反应蛋白（CRP）和降钙素原（PCT）值的流行病学生物标志物研究进行了分析。
共研究了 94 例 DRESS 病例。所有病例的 CRP 值均>10mg/L（正常值上限）。平均 CRP 值为 109.2±79.4mg/L。在无法排除 DRESS 以外炎症原因的 22 例病例中，CRP 值显著更高（均值 162.1 比 92.9mg/L；p=0.003）。受试者工作特征曲线分析显示，CRP 截断值为 99.4mg/L（AUC 0.717）时具有中等性能，可区分有或无其他潜在炎症原因的患者。25 例患者的平均和中位数 PCT 值分别为 2.44±5.94 和 0.69ng/mL。在无法排除 DRESS 以外炎症原因的患者中，中位数 PCT 为 1.37ng/mL（n=9），而仅患有 DRESS 的患者为 0.67ng/mL（n=16）。除 1 例外，所有患者的 PCT 值均高于 0.1ng/mL 的正常截断值，提示存在细菌感染。此外，PCT 值与肝酶测量值之间存在相关性。
评估 CRP 和 PCT 值可能有助于医生区分伴有或不伴有并发感染或其他炎症原因的 DRESS 综合征病例。需要进一步的前瞻性研究来确定这些炎症标志物在 DRESS 管理中的应用。
