1
|
Frick K, Beller EA, Kalisvaart M, Dutkowski P, Schüpbach RA, Klinzing S. Procalcitonin in early allograft dysfunction after orthotopic liver transplantation: a retrospective single centre study. BMC Gastroenterol 2022; 22:404. [PMID: 36045337 PMCID: PMC9429388 DOI: 10.1186/s12876-022-02486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Ischemia–reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT. Methods Patients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed. Results Of 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7–53.8) mcg/l vs. 11.1 (5.3–25.0) mcg/l; p < 0.001 and 27.7 (9.7–51.9) mcg/l vs. 11.5 (5.5–25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD. Conclusion Generally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02486-5.
Collapse
|
2
|
Mahmoud EIED, Algendy MA, Al-Ansary AM, Noaman MK. Evaluation of procalcitonin (PCT) as a marker of infection in early post living donated liver transplant period. Transpl Immunol 2022; 71:101549. [PMID: 35122958 DOI: 10.1016/j.trim.2022.101549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy. Despite its increased use, data in patients with solid organ transplants are limited. The study aimed to assess the frequency of rising PCT associated with infectious complications in immunosuppressed living donated liver transplantation. METHODS A single-center, retrospective observational study. Preoperative patients' demographic data, operative, anesthetic data, and postoperative clinical course were analyzed post-liver transplant (LT) till discharge from the intensive care unit. RESULTS Sixty patients were classified according to the culture results' into a positive culture group & a negative one and then followed up the sepsis variables in each group. Total leukocyte count (TLC) was elevated in the positive culture group in comparison to the negative culture one and was statistically significant (P-value <0.05) till the fourth day postoperative. Procalcitonin was higher in the positive culture group than in the negative one on days 1, 3, and 5 postoperative and was statistically significant (P-value <0.05). The cutoff values in the receiver operating characteristic curve (ROC) with >90% specificity to infection post LT were PCT of ≥9 ng/ml and TLC of ≥17.3/mm3 on day one. CONCLUSIONS Following up PCT level on day one with TLC is essential and will help to detect sepsis and guide early antimicrobial initiation post-liver transplantation. Combined measurements of PCT and TLC with cutoff values of <9 ng/ml and < 17.3/mm3 respectively will help to exclude infections in 83.7% of patients, thus avoiding unnecessary usage of higher generations empiric antimicrobials.
Collapse
|
3
|
Yokose T, Takeuchi M, Obara H, Shinoda M, Kawakubo H, Kitago M, Yagi H, Abe Y, Yamada Y, Matsubara K, Oshima G, Hori S, Fujimura T, Takemura R, Ishii R, Kuroda T, Kitagawa Y. Diagnostic Utility of Presepsin in Infections After Liver Transplantation: A Preliminary Study. Ann Transplant 2021; 26:e933774. [PMID: 34795199 PMCID: PMC8609769 DOI: 10.12659/aot.933774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Infectious complications after solid organ transplantation can be fatal, and early diagnosis and intervention are important. To the best of our knowledge, no study has examined the diagnostic utility of presepsin, a known accurate biomarker, for infectious complications after liver transplantation. This study aimed to evaluate the utility of presepsin for detecting infection and perioperative kinetics of presepsin after liver transplantation. MATERIAL AND METHODS This single-institutional prospective, observational study included 13 patients who underwent living-donor or deceased-donor liver transplantation. Perioperative serum presepsin level was measured 6 times within a week to evaluate its association with infectious complications and compare it with procalcitonin and C-reactive protein levels and leukocyte count. Postoperatively, patients were followed up for 15 days for infectious complications. RESULTS Five of the 13 patients developed infectious complications after liver transplantation. The median time for infection diagnosis was 9 postoperative days (25th-75th percentile, 7-10). Presepsin levels on 5 and 7 postoperative days were significantly higher in patients with infection than in those without (P=0.019 and P=0.011, respectively). In receiver operating characteristic analysis, area under the curve values of presepsin on 5 and 7 postoperative days (0.881 and 0.905, respectively) were higher than those of other biomarkers. The optimal cut-off value of presepsin was 1361 pg/mL on postoperative day 5 and 1375 pg/mL on postoperative day 7. CONCLUSIONS Although this study included a small number of patients, presepsin levels on postoperative days 5 and 7 may be useful indicators for infectious complications after liver transplantation.
Collapse
Affiliation(s)
- Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Masahiro Shinoda
- Digestive Diseases Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yohei Yamada
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Takumi Fujimura
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| |
Collapse
|
4
|
McCreery RJ, Florescu DF, Kalil AC. Sepsis in Immunocompromised Patients Without Human Immunodeficiency Virus. J Infect Dis 2021; 222:S156-S165. [PMID: 32691837 DOI: 10.1093/infdis/jiaa320] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Sepsis remains among the most common complications from infectious diseases worldwide. The morbidity and mortality rates associated with sepsis range from 20% to 50%. The advances in care for patients with an immunocompromised status have been remarkable over the last 2 decades, but sepsis continues to be a major cause of death in this population Immunocompromised patients who are recipients of a solid organ or hematopoietic stem cell transplant are living longer with a better quality of life. However, some of these patients need lifelong treatment with immunosuppressive medications to maintain their transplant status. A consequence of the need for this permanent immunosuppression is the high risk of opportunistic, community, and hospital-acquired infections, all of which can lead to sepsis. In addition, the detection of serious infections may be more challenging owing to patients' lower ability to mount the clinical symptoms that usually accompany sepsis. This article provides an update on the current knowledge of sepsis in immunocompromised patients without human immunodeficiency virus. It reviews the most pertinent causes of sepsis in this population, and addresses the specific diagnostic and therapeutic challenges in neutropenia and solid organ and hematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Randy J McCreery
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Diana F Florescu
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andre C Kalil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
5
|
Positive Role of Procalcitonin Level in the Diagnosis of Infectious Diseases After Liver Transplantation. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.85668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
6
|
Aslan Çetin B, Aydogan Mathyk B, Koroglu N, Temel Yuksel I, Konal M, Erenel H, Atis Aydin A. Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections. J Matern Fetal Neonatal Med 2018; 32:4108-4113. [PMID: 29804483 DOI: 10.1080/14767058.2018.1481949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: Surgical site infections (SSIs) after cesarean section cause maternal morbidity and economic and emotional burdens on society. Our aim is to measure procalcitonin (PCT) levels in patients who developed incisional SSIs after cesarean section while also comparing PCT concentrations between patients who underwent a secondary suture and who did not require a secondary suture.Methods: Ninety-four patients who developed incisional SSI after cesarean section were enrolled in our study. At the time of admission, serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured. The study population was grouped into two, based on the need of a secondary suture and the patients baseline blood tests were compared.Results: The mean serum CRP level was not significant among the groups; however, the median serum PCT level was significantly higher in patients who required a secondary suture (0.21 vs. 0.05 ng/ml, p ≤ .0001). Serum PCT levels were positively correlated with the length of hospital stay (r = 0.72, p = .0001). Area under the curve (AUC) for PCT in predicting the need of a secondary suture was 0.85 (95% CI: 0.772-0.922) and the cutoff point was 0.142 ng/ml with a sensitivity of 75% and specificity of 97.8% (p = .0001).Conclusion: Serum PCT is a promising marker for both diagnosing and predicting the severity of SSIs after cesarean sections.Trial registration: ClinicalTrials.gov identifier: NCT03223233.
Collapse
Affiliation(s)
- Berna Aslan Çetin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Begum Aydogan Mathyk
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - Nadiye Koroglu
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Ilkbal Temel Yuksel
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Merve Konal
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Hakan Erenel
- Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa Medical Faculty, Division of Maternal Fetal Medicine, Istanbul, Turkey
| | - Alev Atis Aydin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Gür A, Oguzturk H, Köse A, Turtay MG, Ersan V, Bayindir Y, Ince V, Gurbuz S, Yucel N. Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection. ACTA ACUST UNITED AC 2018; 31:1179-1185. [PMID: 29102943 DOI: 10.21873/invivo.11187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/14/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation. PATIENTS AND METHODS The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients. RESULTS CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05). CONCLUSION We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.
Collapse
Affiliation(s)
- Ali Gür
- Van Education and Research Hospital, Van, Turkey
| | - Hakan Oguzturk
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adem Köse
- Infection Diseases Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - M Gökhan Turtay
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Yaşar Bayindir
- Infection Diseases Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Volkan Ince
- Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Sukru Gurbuz
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Neslihan Yucel
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| |
Collapse
|
8
|
Ingber RB, Alhammoud A, Murray DP, Abraham R, Dixit A, Naziri Q, Ahmed G, Paulino CB, Urban WP, Craig C, Maheshwari AV, Diebo BG. A Systematic Review and Meta-Analysis of Procalcitonin as a Marker of Postoperative Orthopedic Infections. Orthopedics 2018; 41:e303-e309. [PMID: 29658977 DOI: 10.3928/01477447-20180409-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
Procalcitonin is a serologic marker that increases in response to inflammatory stimuli, especially those of bacterial origin. Postoperative orthopedic periprosthetic infections are often difficult to diagnose. This study systematically reviewed the literature to evaluate the statistical measures of performance of procalcitonin as a marker of postoperative orthopedic infection. This study showed that procalcitonin has a weighted pooled sensitivity of 67.3%, specificity of 69.4%, positive likelihood ratio of 1.778, negative likelihood ratio of 0.423, and diagnostic odds ratio of 5.770. These results illustrate that procalcitonin is an effective serologic marker for postoperative bacterial infections. [Orthopedics. 2018; 41(3):e303-e309.].
Collapse
|
9
|
Mazo C, Borgatta B, Pont T, Sandiumenge A, Moyano S, Roman A, Rello J. Procalcitonin accurately predicts lung transplant adults with low risk of pulmonary graft dysfunction and intensive care mortality. J Crit Care 2017; 44:142-147. [PMID: 29112904 DOI: 10.1016/j.jcrc.2017.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We evaluated the association of procalcitonin (PCT), IL-6-8-10 plasma levels during the first 72h after lung transplantation (LT) with ICU-mortality, oxygenation, primary graft dysfunction (PGD), and one-year graft function after LT. MATERIAL AND METHODS Prospective, observational study. PCT and IL-6-8-10 plasma levels were measured at 24h, 48h and 72h after LT from 100 lung transplant recipients (LTr). Patients were followed until one year after LT. End-points were ICU survival, grade 3 PGD at 72h and one-year graft function. RESULTS Higher PCT at 24h was associated with lower PaO2/FIO2 ratio and Grade 3 PGD over the first 72h after LT (p<0.05). PCT at 24h was higher in the 9 patients who died (2.90 vs 1.47ng/mL, p<0.05), with AUC=0.74 for predicting ICU-mortality. All patients with PCT<2ng/mL at 24h following LT, survived in the ICU (p<0.05). PCT and IL-10 at 48h were correlated with FEV1 (rho=-0.35) and FVC (rho=-0.29) one year after LT. (p<0.05). CONCLUSIONS A breakpoint of PCT<2ng/mL within 24h has a high predictive value to exclude grade 3 PGD at 72h and for ICU survival. Moreover, both PCT and IL-10 within 48h were associated with significantly better graft function one year after surgery.
Collapse
Affiliation(s)
- Cristopher Mazo
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Bárbara Borgatta
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Teresa Pont
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Alberto Sandiumenge
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Silvia Moyano
- Vall d'Hebron Institut de Recerca, Barcelona, Spain.
| | - Antonio Roman
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Pulmonary Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Jordi Rello
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
10
|
Suberviola B, Rellan L, Riera J, Iranzo R, Garcia Campos A, Robles JC, Vicente R, Miñambres E, Santibanez M. Role of biomarkers in early infectious complications after lung transplantation. PLoS One 2017; 12:e0180202. [PMID: 28704503 PMCID: PMC5509107 DOI: 10.1371/journal.pone.0180202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
Background Infections and primary graft dysfunction are devastating complications in the immediate postoperative period following lung transplantation. Nowadays, reliable diagnostic tools are not available. Biomarkers could improve early infection diagnosis. Methods Multicentre prospective observational study that included all centres authorized to perform lung transplantation in Spain. Lung infection and/or primary graft dysfunction presentation during study period (first postoperative week) was determined. Biomarkers were measured on ICU admission and daily till ICU discharge or for the following 6 consecutive postoperative days. Results We included 233 patients. Median PCT levels were significantly lower in patients with no infection than in patients with Infection on all follow up days. PCT levels were similar for PGD grades 1 and 2 and increased significantly in grade 3. CRP levels were similar in all groups, and no significant differences were observed at any study time point. In the absence of PGD grade 3, PCT levels above median (0.50 ng/ml on admission or 1.17 ng/ml on day 1) were significantly associated with more than two- and three-fold increase in the risk of infection (adjusted Odds Ratio 2.37, 95% confidence interval 1.06 to 5.30 and 3.44, 95% confidence interval 1.52 to 7.78, respectively). Conclusions In the absence of severe primary graft dysfunction, procalcitonin can be useful in detecting infections during the first postoperative week. PGD grade 3 significantly increases PCT levels and interferes with the capacity of PCT as a marker of infection. PCT was superior to CRP in the diagnosis of infection during the study period.
Collapse
Affiliation(s)
- Borja Suberviola
- Critical Care Department, Hospital Universitario Marqués de Valdecilla – IDIVAL, Santander, Spain
- * E-mail:
| | - Luzdivina Rellan
- Department of Anesthesiology, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | - Jordi Riera
- Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Reyes Iranzo
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Juan Carlos Robles
- Transplant Coordination Unit, Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Rosario Vicente
- Department of Anesthesiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Eduardo Miñambres
- Critical Care Department - Transplant Coordination Unit, Hospital Universitario Marques de Valdecilla – IDIVAL, Santander, Spain
| | | |
Collapse
|
11
|
Cousin VL, Lambert K, Trabelsi S, Galetto-Lacour A, Posfay-Barbe KM, Wildhaber BE, McLin VA. Procalcitonin for infections in the first week after pediatric liver transplantation. BMC Infect Dis 2017; 17:149. [PMID: 28201980 PMCID: PMC5311857 DOI: 10.1186/s12879-017-2234-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/31/2017] [Indexed: 01/05/2023] Open
Abstract
Background Procalcitonin (PCT) has become a commonly used serum inflammatory marker. Our aim was to describe the kinetics and usefulness of serial post-operative PCT measurements to detect bacterial infection in a cohort of children immediately after pediatric liver transplantation (pLT). Methods We performed a retrospective chart review of a cohort of pLT recipients with serial serum PCT measurements in the first week following pLT. The presence of infection was determined on clinical and biological parameters. Normal PCT was defined as < 0.5 (ng/ml). Results Thirty-nine patients underwent 41 pLT. PCT was measured daily during the first week post pLT. Values first increased following surgery and then decreased, nearing 0.5 ng/ml at day seven. Peak PCT reached a median of 5.61 ng/ml (IQR 3.83-10.8). Seventeen patients were considered to have an infection. There was no significant difference in daily PCT or peak PCT between infected and non infected patients during the first post-operative week. AUC of ROC curve for PCT during first week was never higher than 0.6. Conclusions We conclude that serial PCT measurements during the first week after pLT is not useful to identify patients with bacterial infections. Rather, we propose that serum PCT may be useful after the first week post pLT. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2234-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vladimir L Cousin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Rue Willy-Donzé 6, 1211, Geneva, Switzerland.
| | | | | | | | - Klara M Posfay-Barbe
- Pediatric Infectious Disease Unit, Department of Pediatrics, University Hospitals Geneva & University of Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Valérie A McLin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Rue Willy-Donzé 6, 1211, Geneva, Switzerland
| |
Collapse
|
12
|
Perrakis A, Stirkat F, Croner RS, Vassos N, Raptis D, Yedibela S, Hohenberger W, Müller V. Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation. Arch Med Sci 2016; 12:372-9. [PMID: 27186183 PMCID: PMC4848368 DOI: 10.5114/aoms.2016.59264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the diagnostic accuracy of procalcitonin (PCT) as a marker for complications and as a prognostic factor for mortality after liver transplantation. MATERIAL AND METHODS Liver transplant patients between January 2007 and April 2011 were prospectively included in the study. Procalcitonin serum concentration was recorded before, 6 h after reperfusion and then daily. Postoperative clinical course was prospectively analyzed from admission to discharge. Main surgical data such as operating procedure, type of reperfusion, operating and ischemic times, high urgency (HU) status and MELD score at the time of transplantation were also recorded. RESULTS Sixteen patients with initial PCT > 5 ng/ml suffered ≥ 1 complication (p = 0.03). However, there was no association between the level of the 1(st) peak PCT and the further postoperative course or the occurrence of complications. Patients in whom a 2(nd) PCT peak occurred had a significantly higher risk for a complicated course, for a complicated sepsis course and for mortality (p < 0.0001). Warm ischemic time over 58 min, operating time over 389 min and HU status were significant independent factors for a complicated postoperative course (p < 0.001, p < 0.001 and p = 0.03 respectively). CONCLUSIONS Based on our results, we believe that PCT course and the occurrence of a 2(nd) peak seem to possess important diagnostic and prognostic power in the post-transplant setting after liver transplantation.
Collapse
Affiliation(s)
| | - Falk Stirkat
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Süleyman Yedibela
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Volker Müller
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
13
|
Dai X, Fu C, Wang C, Cai Y, Zhang S, Guo W, Kuang D. The impact of tracheotomy on levels of procalcitonin in patients without sepsis: a prospective study. Clinics (Sao Paulo) 2015; 70:612-7. [PMID: 26375562 PMCID: PMC4557591 DOI: 10.6061/clinics/2015(09)03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Procalcitonin is a reliable biomarker of infection and sepsis. We aimed to determine whether tracheotomy influences the procalcitonin concentrations in patients without sepsis and assess whether operative duration and procedure affect the peak procalcitonin level. METHODS A total of 38 non-septic patients who required a tracheotomy underwent either a percutaneous dilatational tracheotomy (n=19) or a surgical tracheotomy (n=19). Procalcitonin levels were measured at the beginning of the tracheotomy and at 2 h, 4 h, 8 h, 24 h, 48 h and 72 h after the procedure. RESULTS The baseline procalcitonin concentration before the tracheotomy was 0.24 ± 0.13 ng/mL. The postoperative levels increased rapidly, with a 4-fold elevation after 2 h, reaching a peak 4 h later with a 5-fold increase over baseline. Thereafter, the levels gradually returned to 2-fold greater than the baseline level within 72 h. The peak levels of procalcitonin showed a significant positive correlation with operative durations (r=0.710, p<0.001) and procedures (rho=0.670, p<0.001). CONCLUSION In patients without sepsis, tracheotomy induces a rapid release of serum procalcitonin, and the operative duration and procedure have significant impacts on the peak procalcitonin levels. Thus, the nonspecific increase in procalcitonin levels following tracheotomy needs to be considered when this measure is used to evaluate infection.
Collapse
Affiliation(s)
- Xingui Dai
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
- Corresponding author: E-mail:
| | - Chunlai Fu
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
| | - Changfa Wang
- Central South University, Third Xiangya Hospital, Department of General Surgery, Changsha, Hunan, China
| | - Yeping Cai
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
| | - Sheng'an Zhang
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
| | - Wei Guo
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
| | - Daibing Kuang
- The First People's Hospital of Chenzhou, Institute of Translational Medicine, Department of Critical Care Medicine, Chenzhou, Hunan, China
| |
Collapse
|
14
|
Sandkovsky U, Kalil AC, Florescu DF. The use and value of procalcitonin in solid organ transplantation. Clin Transplant 2015; 29:689-96. [PMID: 25996831 DOI: 10.1111/ctr.12568] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/01/2023]
Abstract
Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy, especially in lower respiratory tract and bloodstream infections. Despite its increased use, data in patients with solid organ transplants are limited. Even without the presence of infection, PCT increases as a result of surgical procedures during transplantation, implantation of devices, and use of induction immunosuppressive therapy. The risk of infection is also higher in solid organ transplant recipients when compared to the general population. Monitoring PCT in the early post-transplant period seems to be a promising method for early detection of infectious complications. It has been shown that elevated PCT levels after one wk of transplantation are correlated with infectious complications. PCT may be a useful adjunctive biomarker that may improve early identification and guide appropriate treatment of infection or rejection, with the potential to further improve clinical outcomes. The use of serial PCT measurements may be more reliable than single values. It is important to recognize which factors may lead to PCT increases in the post-transplantation period, which in turn will help understand the kinetics and utility of this biomarker in this important patient population.
Collapse
Affiliation(s)
- Uriel Sandkovsky
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andre C Kalil
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana F Florescu
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.,Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
15
|
Kaido T, Ogawa K, Fujimoto Y, Mori A, Hatano E, Okajima H, Uemoto S. Perioperative changes of procalcitonin levels in patients undergoing liver transplantation. Transpl Infect Dis 2014; 16:790-6. [PMID: 25154523 DOI: 10.1111/tid.12282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/20/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe sepsis is a life-threatening complication after liver transplantation (LT) that can be difficult to diagnose and appropriately treat after LT because of patients being treated with immunosuppressants. The present study examines perioperative changes in serum procalcitonin (PCT), a specific marker of systemic bacterial infection, and determines the value of PCT as a diagnostic tool for bacteremia or rejection. METHODS Perioperative serum PCT levels were prospectively assessed in 104 consecutive adult patients undergoing LT (living-donor LT, n = 90; deceased-donor LT, n = 14) between May 2010 and August 2012. RESULTS Serum PCT levels remarkably increased soon after LT and gradually decreased thereafter, but were not increased in patients diagnosed with cytomegalovirus infection or acute cellular rejection. Serum PCT levels in patients who underwent deceased-donor LT were significantly higher than in those who underwent living-donor LT until postoperative day (POD) 7. Serum PCT levels were significantly higher in patients with bacteremia than in those without bacteremia after POD 14. In patients with post-transplant bacteremia, PCT levels increased again after POD 7 in patients who died within 3 months of LT, while levels remained low after POD 7 in patients who were alive. A positive predictive value of 83.3% for bacteremia and a negative predictive value of 97.4% were obtained at PCT cutoffs of 2.0 and 0.5 ng/mL, respectively. CONCLUSION Serum PCT measurement, using appropriate cutoff values, could help diagnose severe infection, and might be able to differentiate bacteremia from acute cellular rejection.
Collapse
Affiliation(s)
- T Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
16
|
Watkins RR, Lemonovich TL. Serum procalcitonin in the diagnosis and management of intra-abdominal infections. Expert Rev Anti Infect Ther 2014; 10:197-205. [DOI: 10.1586/eri.11.164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
17
|
Choi HJ. Procalcitonin in diagnosis of post-operative bacterial meningitis: a promising but limited role. Infect Chemother 2014; 45:346-8. [PMID: 24396639 PMCID: PMC3848510 DOI: 10.3947/ic.2013.45.3.346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Takakura Y, Hinoi T, Egi H, Shimomura M, Adachi T, Saito Y, Tanimine N, Miguchi M, Ohdan H. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg 2013; 398:833-9. [PMID: 23784676 DOI: 10.1007/s00423-013-1095-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/11/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE Surgical site infection (SSI) is a frequent complication of elective surgery for colorectal cancer. The classical clinical markers of infection-elevations in white blood cell count, C-reactive protein (CRP) level, and body temperature-do not precisely predict SSI after elective colorectal resection. The objective of this study was to evaluate the efficacy of procalcitonin (PCT) as a tool for diagnosis of SSI in elective surgery for colorectal cancer. METHODS A total of 114 consecutive patients undergoing elective colorectal resection for cancer were evaluated. Routine blood samples, for determining PCT level, CRP plasma concentration, and white blood cell count, were obtained on postoperative days (POD) 1 and 3. Predictive values for each of the laboratory markers were examined. RESULTS SSI was diagnosed in 18 (15.7 %) of 114 patients. Patients with SSI exhibited significantly higher PCT levels (on PODs 1 and 3) and CRP levels (on POD 3) than did patients without SSI. According to receiver operating characteristic analysis, PCT showed the highest area under the curve (AUC) for predicting SSI on both PODs 1 and 3 (AUC, 0.76 and 0.77, respectively). Multivariate logistic regression analysis showed that PCT (on PODs 1 and 3) was an independent predictor for SSI (odds ratio = 14.41 and 9.79, respectively). CONCLUSION Serum PCT is more reliable laboratory marker for the early diagnosis of SSI after elective colorectal cancer surgery, compared with conventional inflammatory indicators. PCT could serve as an additional diagnostic tool for the early identification of SSI to improve clinical decision making.
Collapse
Affiliation(s)
- Yuji Takakura
- Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Traditional biomarkers, including C-reactive protein, leukocytes, erythrocyte sedimentation rate, and clinical signs and symptoms, are not sufficiently sensitive or specific enough to guide treatment decisions in infectious febrile diseases. Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. A growing body of evidence supports the use of PCT as a marker to improve the diagnosis of bacterial infections and to guide antibiotic therapy. Clinically, PCT levels may help guide the need for empirical antibiotic therapy, source control for infections, and duration of antibiotic therapy. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker in order to provide physicians with an overview of the potential for PCT to guide antibiotic therapy.
Collapse
Affiliation(s)
- Hyuck Lee
- Division of Infectious Diseases, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.
| |
Collapse
|
20
|
Suberviola B, Castellanos-Ortega A, Ballesteros M, Zurbano F, Naranjo S, Miñambres E. Early identification of infectious complications in lung transplant recipients using procalcitonin. Transpl Infect Dis 2012; 14:461-7. [DOI: 10.1111/j.1399-3062.2012.00780.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/01/2012] [Accepted: 04/26/2012] [Indexed: 11/28/2022]
Affiliation(s)
- B. Suberviola
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - A. Castellanos-Ortega
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - M.A. Ballesteros
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - F. Zurbano
- Department of Respiratory Medicine; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - S. Naranjo
- Department of Thoracic Surgery; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | | |
Collapse
|
21
|
[Causes of early mortality after liver transplantation: a twenty-years single centre experience]. ACTA ACUST UNITED AC 2011; 30:899-904. [PMID: 22035834 DOI: 10.1016/j.annfar.2011.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/21/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To define the causes of mortality of patients who died within the first three months after a liver transplantation. TYPE OF STUDY Retrospective, observational, and single centre study. PATIENTS AND METHODS Between March 1989 and July 2010, all patients who died within three months after a liver transplantation were included. Demographic characteristics, preoperative and peroperative data, donor characteristics, postoperative complications and causes of mortality were collected. RESULTS Among the 788 performed liver transplantations, 76 patients died in intensive care unit (11%). The main indications of liver transplantation were alcoholic cirrhosis (30%), hepatitis C (28%), hepatocarcinoma (15%), primitive or secondary biliary cirrhosis (10%). Fifty percent of the patients were categorized as Child C. The main causes of death were non-function or dysfunction with retransplantation contra-indication graft (18%), sepsis (18%), neurological complications (12%), hemorrhagic shock (13%), (9%), multiorgan failures (5%), cardiac complications (6%). CONCLUSION In this study, the main causes of mortality were infectious, neurological and hemorrhagic. These results emphasize the necessity for better control of sepsis, haemorrhage and immunosupressors.
Collapse
|