Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
J Cancer Res Clin Oncol. 2019 Oct;145(10):2625-2631. doi: 10.1007/s00432-019-03002-1. Epub 2019 Sep 6.
Immune checkpoint inhibitors (ICIs) are effective against a wide variety of cancers. However, they also induce a plethora of unique immune-related adverse events (irAEs). Since for many organ systems symptoms can be unspecific, differential diagnosis with progression of disease or infection may be difficult. C-reactive protein (CRP) has been suggested as a marker for infection. The purpose of this study was to evaluate the diagnostic value of CRP in differentiating infectious causes from autoimmune side effects induced by ICIs.
In order to investigate the role of CRP in irAEs, we screened our patient data base. Only events with full infectious workup were included. In total 88 events of irAEs in 37 melanoma patients were analyzed. CRP levels before and during irAEs were evaluated. Statistical analyses were conducted using the Chi-square test for categorical variables.
At the onset of irAE, CRP rose in 93% of cases to a mean of 52.7 mg/L (CI 35.1-70.3) from 8.4 mg/L at baseline (normal < 5 mg/L) (P < 0.0001). Other causes of CRP elevation including infectious diseases were excluded, and procalcitonin (PCT) levels were normal in 92% of events. Importantly, in 42% of cases CRP elevations preceded clinical symptoms.
CRP elevation can predict the onset of irAEs in patients treated with ICIs in the absence of infectious disease.
免疫检查点抑制剂（ICIs）对多种癌症有效。然而，它们也会引起大量独特的免疫相关不良反应（irAEs）。由于许多器官系统的症状可能不特异，因此与疾病进展或感染的鉴别诊断可能很困难。C 反应蛋白（CRP）已被提议作为感染的标志物。本研究旨在评估 CRP 在鉴别由 ICI 引起的感染性病因和自身免疫副作用方面的诊断价值。
为了研究 CRP 在 irAEs 中的作用，我们筛选了我们的患者数据库。仅纳入了进行了全面感染性检查的事件。共分析了 37 例黑色素瘤患者 88 例 irAEs 事件。评估了 irAEs 发生前后的 CRP 水平。使用卡方检验对分类变量进行统计分析。
在 irAE 发作时，93%的病例 CRP 升高，均值为 52.7mg/L（CI 35.1-70.3），基线时为 8.4mg/L（正常 < 5mg/L）（P < 0.0001）。排除其他导致 CRP 升高的原因，包括感染性疾病，92%的事件降钙素原（PCT）水平正常。重要的是，在 42%的病例中，CRP 升高先于临床症状。
在没有感染性疾病的情况下，CRP 升高可预测接受 ICI 治疗的患者发生 irAEs。
