Association Between Procalcitonin and Post-hepatectomy Liver Failure in Hepatocellular Carcinoma Patients

Abstract

Objectives: Procalcitonin (PCT) has long been proved as an early diagnostic signal for postoperative outcomes. The purpose of this study is to explore the value of serum procalcitonin levels in predicting post-hepatectomy liver failure (PHLF), and further to declarethe relationship between postoperative PCT and short-term prognosis in patients after hepatectomy.Methods: Clinical data of patients with hepatocellular carcinoma (HCC) who underwent hepatectomy from June 1st, 2019 to September 31st, 2020 at Shanghai Eastern Hepatobiliary Surgery Hospital had been retrospectively analyzed. Logistic regression analysis was used to evaluate the risk factors related to PHLF. The Kaplan-Meier method was used to calculate the PHLF rate and 30-day survival after surgery.Results: A total of 885 patients with complete data were finally included in analysis, 311 of them with elevated serum PCT (≥1 ng/ml). Results of the logistic regression analysis suggested a significant association between PCT and PHLF [HR, 95%CI; 3.801 (1.825, 7.917), p < 0.001]. Other significant risk factors for PHLF included portal hypertension, portal blocking time (>30 min) and blood transfusion (>200 ml). Kaplan-Meier analysis also suggested a higher PHLF rate in elevated PCT patients [9.0% (95% CI, 7.3 to 12.8 VS. 1.9% (95% CI, 1.1–4.3)); p < 0.001]. For secondary outcomes, elevated PCT was also highly associated with postoperative sepsis, ICU admission, 30-day mortality and 3-month mortality.Conclusion: Elevated procalcitonin level in patients after hepatectomy is related to higher PHLF rate, with lower 30-day survival and poor short-term postoperative outcomes.

Diagnostic Potential of Inflammatory Biomarker Levels in the Serum of Patients with Hepatitis B Infection: A Retrospective Study

“…Further studies are necessary to establish a more comprehensive understanding of the interplay between viral replication, inflammation, and the host immune response in HBV infection. Previous studies have reported conflicting findings regarding the relationship between inflammatory markers and liver function in HBV infection, with some studies indicating increased CRP levels and indeterminate increases in PCT levels (Sproston and Ashworth, 2018;Igna et al, 2022;Li et al, 2021). In our study, we observed a significant increase in both CRP and PCT levels in patients with HBV infection compared with the levels in healthy individuals, but no significant differences were found based on age or sex.…”

“…Furthermore, due to the retrospective nature of data collection and study design, other inflammatory biomarkers such as D-dimer (an initial indicator of inflammatory activity (Tan et al, 2018)) and IL-6 (a key marker influencing the liver and neurons (Surial et al, 2021)) were not included. Hence, future studies should investigate the levels of these important inflammatory markers alongside CRP and PCT in serum (Dong et al, 2019;Li et al, 2021), as well as explore other potential biomarkers, including cardiac and inflammatory markers, to better understand their association with hepatitis B. Additionally, it is important to evaluate whether the observed increasing trend of CRP and PCT in serum is specific to hepatitis B or if it is also observed in other liver diseases such as liver cirrhosis and liver cancer. Comparative data on CRP and PCT levels in the serum of patients with HBV infection and other liver diseases should be included in future research to determine the specificity of this increasing trend in hepatitis B patients.…”

“…Moreover, it is worth noting that in patients with decompensated liver cirrhosis, a high PCT concentration has shown high sensitivity and specificity for bacterial infections (Yuan et al, 2013). However, since biomarkers such as PCT and CRP are measured after confirmation and hospitalization of patients with hepatitis B, they are considered useful for monitoring and predicting the progression of hematologic activity, such as complete blood count, erythrocyte sedimentation rate, or white blood cell count (Li et al, 2021;Chen et al, 2020). Additionally, due to administrative approaches and temporary operations of the hospital, only patients with quantitatively confirmed positive or negative hepatitis B diagnoses were managed.…”

Comparison of bicarbonate Ringer’s solution with lactated Ringer’s solution among postoperative outcomes in patients with laparoscopic right hemihepatectomy: a single-centre randomised controlled trial

“…It is pertinent to record that Mg 2+ , Na + and K + concentration often decreased in hepatic insufficiency caused by hepatectomy [ 28 – 30 ]. This is associated with decreased albumin as well as multiple disordered hormone secretion [ 28 , 31 , 32 ]. When liver function is impaired, aldosterone and antidiuretic hormone inactivation is reduced that leads to increased potassium excretion and dilutive hyponatremia [ 32 , 33 ].…”

Inflammatory Dysfunction in Hepatitis B-Positive Individuals: Quantitative Assessment of C-reactive protein (CRP) and Procalcitonin (PCT) Levels Using Immunofluorescence Assay

“…However, it is important to note that the exact cause-and-effect relationship between inflammatory biomarkers and HBV replication or liver inflammation cannot be determined solely based on these findings. Further studies are warranted to establish a more comprehensive understanding of the interplay between viral replication, inflammation, and the host immune response in HBV infection [23].…”