calca-protein--human and Liver-Diseases

To explore the clinical value of serum procalcitonin (PCT) for predicting spontaneous bacterial peritonitis (SBP) in end-stage liver diseases.. The clinical data of 362 ascitic inpatients with end-stage liver diseases who had underwent serum PCT assay in our department from March 2011 to June 2013 were analyzed retrospectively. These patients were then divided into SBP group (n=178) and non-SBP group (n=184). The dynamic changes of the PCT values upon admission and after antibiotic treatment were compared. The receiver operating characteristic curve was drawn to identify the optimal cut-off value of serum PCT in diagnosing SBP.. The positive rate of bacteria culture in ascites was only 4.6% (4/87) in SBP group. The median value of serum PCT was 0.73 and 0.15 ng/ml in SBP group and non-SBP group (Z=-11.9, U=0.000), respectively, before antibiotic treatment. In the SBP group, the median value of serum PCT was 1.73 ng/ml in 13 patients with positive culture findings, which was higher than the overall median value in SBP group. Among patients who were responsive to the antibiotic therapy, the median values of serum PCT were 0.40(n=46), 0.32(n=19), and 0.33 ng/ml(n=25), respectively, 3, 5, and 7 days after the effective antibiotics treatment, which were significantly lower than the pre-treatment levels [0.86(Z=-5.91, U=0.000), 0.72(Z=-3.10, U=0.002), and 0.79 ng/ml(Z=-4.37, U=0.000), respectively]. ROC analysis showed that a serum PCT value of more than 0.462 ng/ml had a sensitivity of 83.7% and a specificity of 94.9%(AUC:0.95, 95%CI:0.93-0.97, P=0.00) in diagnosing SBP in patients with end-stage liver diseases.. Ascitic fluid positive rate is low in SBP patients. Serum PCT is a sensitive and specific marker for predicting peritoneal bacteria infection in end-stage liver disease patients with ascites. Higher serum PCT can be expected in these patients with heavier infections, it can also be used to evaluate the effectiveness of anti-bacteria therapies.

Topics: Adult; Aged; Ascitic Fluid; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Liver Diseases; Male; Middle Aged; Peritonitis; Protein Precursors; Retrospective Studies; Sensitivity and Specificity

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.. 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.. 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.. Serum PCT measurement, using appropriate cutoff values, could help diagnose severe infection, and might be able to differentiate bacteremia from acute cellular rejection.

Topics: Adult; Aged; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytomegalovirus Infections; Female; Graft Rejection; Humans; Immunity, Cellular; Liver Diseases; Liver Transplantation; Living Donors; Male; Middle Aged; Perioperative Period; Predictive Value of Tests; Prospective Studies; Protein Precursors; Time Factors; Young Adult

Sepsis is the leading cause of mortality in intensive care units. Early detection and intervention are critical to prevent death. The acute radiation syndrome is characterized by damage of the gastrointestinal and hematopoietic systems. Translocation of intestinal microflora combined with immune system compromise may lead to septicemia and death. This work examined the utility of procalcitonin, a clinical sepsis biomarker, in a mouse model of radiation toxicity. C57/BL6 mice were exposed to total body irradiation (TBI). Intestinal mucosal permeability was measured in vivo, and liver bacterial load and plasma levels of procalcitonin (PCT), lipopolysaccharide (LPS), and LPS-binding protein were measured at baseline and at 3.5, 7, and 10 days after TBI. The value of early PCT in predicting subsequent lethality was determined by receiver operating characteristic analysis. Four days after TBI, a dose-dependent increase in permeability of the intestinal mucosa was observed, whereas bacterial translocation was present from day 7 onward. There was a high positive correlation between bacterial translocation and all sepsis biomarkers, with PCT exhibiting the strongest correlation. Moreover, plasma PCT levels were elevated already from day 3.5 onward, whereas LPS was elevated from day 7 and LPS-binding protein only 10 days after TBI. Receiver operating characteristic analysis revealed that PCT levels measured 3.5 days after TBI predicted lethality at 10 days. These data demonstrate the value of PCT as an early biomarker in radiation-induced bacteremia for mouse studies and suggest that clinical results from other septic conditions may apply to postradiation septicemia in humans.

Topics: Acute-Phase Proteins; Animals; Bacteremia; Bacterial Load; Bacterial Translocation; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Enzyme-Linked Immunosorbent Assay; Fluorescence; Intestinal Mucosa; Lipopolysaccharides; Liver; Liver Diseases; Membrane Glycoproteins; Mice; Mice, Inbred C57BL; Permeability; Protein Precursors; Radiation Injuries, Experimental; ROC Curve; Whole-Body Irradiation

Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT.. We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group.. The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT <5 ng/mL and 10 above. The complication group included 14 patients who underwent 15 transplantations; Only 1 displayed a peakPCT <5 ng/mL. When the peak-PCT was >5 ng/mL, the odds ratio of a complication was 11.2 (95% Confidence interval, 10.81-11.59; P < .025). However, not before the 7th postoperative day was the course of mean PCT levels significantly different between the complication and noncomplication groups. In transplant patients, an elevation of PCT was observed only in the presence of bacterial infection and not rejection or wound infection. PCT rose during respiratory failure and sepsis, but not renal replacement therapy, ascites, pleural effusion, rejection, or bleeding.. PCT was a reliable marker. A decline was observed in 31 cases with subject, who both had fatal outcomes showing a constantly rising level. An initial high PCT indicated a poor prognosis; some members of the noncomplication group also had levels >15 ng/mL. The patients in the complication group showed a higher mean PCT, which was significant at 7 days, most probably because of the high variation among levels. Still, a peak-PCT >5 ng/mL showed an odds ratio of 11.2 for patients to experience a complication.

Topics: Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Liver Diseases; Liver Transplantation; Postoperative Period; Prognosis; Protein Precursors

Serum procalcitonin was measured in 58 children with symptoms and signs of hepatic disease. According to mechanism responsible for liver injury, children were assigned to one of 4 categories: 1, invasive bacterial infection; 2, acute viral infection; 3, toxic liver injury; and 4, autoimmune disease. Procalcitonin concentrations exceeded normal values in all children with invasive bacterial infection. It was low in viral infection and toxic liver injury. Moderately elevated procalcitonin concentrations were present in 50% of children with an autoimmune process.

Topics: Adolescent; Autoimmune Diseases; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Humans; Infant; Liver Diseases; Protein Precursors; Virus Diseases