{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:59:47Z","timestamp":1791989987173,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001407","name":"Department of Biotechnology, Ministry of Science and Technology, India","doi-asserted-by":"publisher","award":["BT\/PR23111\/MED\/30\/1852\/2017"],"award-info":[{"award-number":["BT\/PR23111\/MED\/30\/1852\/2017"]}],"id":[{"id":"10.13039\/501100001407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aim and Objectives<\/jats:title><jats:p>To assess the role of newer biomarkers like neutrophil Z, myeloid\u2010related protein 8\/14 (MRP 8\/14), IL\u20106, sCD14, and neutrophil CD64 (nCD64) to distinguish flare from infection in febrile lupus patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective multicentric observational study to determine the etiology of fever in febrile lupus patients, in addition to routine tests, serum procalcitonin, neutrophil X, neutrophil Y, and neutrophil Z were done. sCD14, MRP8\/14, and IL\u20106 were done by ELISA. nCD64 expression was measured by flow cytometry. All these biomarkers were assessed individually and in combination to see their ability to distinguish between infection and lupus flare.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 159 febrile SLE patients, there were 55 infections, 65 disease flares, 38 flares and infections combined, and 1 malignancy. Patients with bacterial infections had a higher CRP, procalcitonin, neutrophil\u2010to\u2010lymphocyte ratio, Neutrophil Z, sCD14 levels, and neutrophil CD64 expression. While patients with flares had lower C3, C4, and higher anti\u2010DsDNA antibody levels. IL\u20106 and MRP8\/14 levels were similar in both groups. Combination of neut\u2010Z with C3 or anti\u2010dsDNA antibody could discriminate between flare and infection with AUC 0.88 (0.80\u20130.96) and 0.86 (0.78\u20130.95). Addition of TLC or procalcitonin or nCD64 MFI to these scores improved them marginally. Though composite scores with CRP and anti\u2010dsDNA\/procalcitonin also performed well but these were inferior to neutrophil Z\u2010based composite models. These results were consistent in sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Neutrophil Z, complement <jats:styled-content style=\"fixed-case\">C3<\/jats:styled-content>, anti\u2010<jats:styled-content style=\"fixed-case\">dsDNA<\/jats:styled-content> antibody levels, and <jats:styled-content style=\"fixed-case\">TLC<\/jats:styled-content> or procalcitonin\u2010based composite score are good tools to differentiate between infection and flare in a febrile lupus patient. Serum <jats:styled-content style=\"fixed-case\">MRP<\/jats:styled-content> 8\/14, <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106, <jats:styled-content style=\"fixed-case\">sCD14<\/jats:styled-content>, and <jats:styled-content style=\"fixed-case\">nCD64<\/jats:styled-content> did not perform well. Simple biomarkers such as neut\u2010Z should be investigated further in <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.70243","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T05:12:02Z","timestamp":1745989922000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neutrophil Z Is a Novel Marker to Differentiate Disease Flares From Bacterial Infections in Febrile <scp>SLE<\/scp> Patients"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3192-6088","authenticated-orcid":false,"given":"Kishan","family":"Majithiya","sequence":"first","affiliation":[{"name":"Department of Clinical Immunology &amp; Rheumatology Sanjay Gandhi Postgraduate Institute of Medical Sciences  Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Komal","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology &amp; Rheumatology Sanjay Gandhi Postgraduate Institute of Medical Sciences  Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9134-0999","authenticated-orcid":false,"given":"Pankti","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology &amp; Rheumatology Sanjay Gandhi Postgraduate Institute of Medical Sciences  Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-3989","authenticated-orcid":false,"given":"Chengappa","family":"Kavadichanda","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology JIPMER  Puducherry India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5886-2410","authenticated-orcid":false,"given":"M. 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