Procalcitonin as a prognostic marker for infectious complications in liver transplant recipients in an intensive care unit

Abstract

Clinically significant infections (CSIs) are life-threatening but difficult to diagnose after liver transplantation (LTx). This study investigates the value of procalcitonin (PCT) in addition to c-reactive protein (CRP) and the leukocyte count (LC) as a prognostic marker for CSIs in LTx recipients. The clinical course of 135 LTx recipients was prospectively studied. CSIs were defined as pulmonary, bloodstream, or intra-abdominal infections. Independent risk factors for CSIs were determined by Cox proportional hazard analysis. The concordance statistics (c-statistics) were used to assess the discrimination effect of PCT. Thirty recipients (22%) experienced a CSI. They had significantly higher peak PCT (27.2 versus 12.7 ng/mL, P = 0.014) and peak CRP (13.7 versus 9.9 mg/dL, P < 0.001) and a tendency toward a higher peak LC (19.3 versus 14.2 cells/nL, P = 0.051) in comparison with recipients without CSIs. Independent risk factors for CSIs were male sex [hazard ratio (HR) = 6.4], a body mass index (BMI) < 20 kg/m(2) (versus a BMI > 25 kg/m(2), HR = 13.8), acute liver failure as an indication for LTx (HR = 7.1), a cold ischemic time > 420 minutes (HR = 3.5), and peak CRP (HR = 1.1) but not peak PCT. The addition of peak PCT marginally improved the c-statistic from 0.815 to 0.827. In conclusion, although peak PCT differed significantly between recipients with and without CSIs, it was not an independent risk factor for CSIs and added little prognostic accuracy. Interestingly, the parameters peak CRP, male sex, low BMI, acute liver failure, and long cold ischemic time were independent risk factors for CSIs. They could serve as risk stratifiers directing medical therapy in clinical practice.

Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection

“…The CRP value was significantly (p<0.001) in infected patients with liver transplant as in our study (9). This enforced the idea that CRP was a parameter that could be used as an indication of infection in liver transplant patients.…”

“…In another study, it was found that 135 (93%) liver transplant patients had clinically significant infections. 81 (60%) of these patients were male and the mean age was 52 (range=18-69) (9).…”

The Role of Procalcitonin in the Early Diagnosis of Septic and Non-Septic Complications in the Immediate Postoperative Setting After Orthotopic Liver Transplantation

“…This fact presents the major limitation of PCT's diagnostic power. Additionally the presence of viral infection did not stimulate a PCT elevation and cannot be diagnosed through this inflammation marker [32,.…”

“…In the posttransplant setting, elevated PCT levels are observed in the first 2-3 days after OLT [1]. Initially high PCT levels, however, do not necessarily indicate a poor prognosis as do continuous or secondarily rising levels [32,42]. Cardiac arrest and infection, but not PCT level in the donor, are associated with high post-OLT PCT levels in the recipient [43].…”

“…Van den Broek et al [32] in a large study with 135 patients (LDLT and deceased donor recipients) examined the diagnostic and prognostic accuracy of PCT in cases of critical systemic infections in comparison to other traditional inflammation markes such as CRP and leucocyte count (LC). In this study peak PCT was found not to be an independent factor for occurrence of serious infections and septic episodes.…”