C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation

Abstract

The relationship between aseptic systemic inflammation and postoperative bacterial infection is unclear. We investigated the correlation of systemic inflammation biomarkers with 30-day clinically significant bacterial infections (CSI) after liver transplantation (LT). This retrospective study enrolled 940 patients who received LT and were followed for 30 days. The primary end point was 30-day CSI events. The cohort was divided into exploratory (n = 508) and validation (n = 432) sets according to different centers. Area under the receiver operated characteristic (AUROC) and Cox regression models were fitted to study the association between baseline systemic inflammation levels and CSI after LT. A total of 255 bacterial infectious events in 209 recipients occurred. Among systemic inflammation parameters, baseline C-reactive protein (CRP) was independently associated with 30-day CSI in the exploratory group. The combination of CRP and organ failure number showed a good discrimination for 30-day CSI (AUROC = 0.80, 95% CI, 0.76–0.84) and the results were confirmed in an external verification group. Additionally, CRP levels were correlated with bacterial product lipopolysaccharide. In conclusion, our study suggests that pre-transplantation CRP is independent of other prognostic factors for 30-day CSI post-LT, and can be integrated into tools for assessing the risk of bacterial infection post-LT or as a component of prognostic models.

Galectin‐3 is overexpressed in advanced cirrhosis and predicts post‐liver transplant infectious complications

“…Given the important effect modification between these variables, this could have explained why a multivariable regression model was not significant. Although pre‐transplant evaluation of systemic inflammation biomarkers including C‐reactive protein has been found to predict bacterial infections during the early posttransplant period, 32 to our knowledge a direct implication of SIRS on the development of infectious complications in general has not been previously reported.…”

Dd-cfDNA in liver transplantation: The future of non-invasive liver graft evaluation

“…There has already been found a correlation between graft dysfunction, pathologies, and different types of biomarkers including nucleic and protein ones, metabolites, and the recently discovered extracellular vesicles [29][30][31]. Among protein biomarkers are those involved in immune responses, like in complement system activation (C3a, C5a, and sC5b-9), C-reactive Protein, cytokines, MHC class I polypeptides, and different types of CD blood cells, enzymes such as ATP citrate lyase, apolipoprotein A1, and butyrylcholinesterase, structural proteins such as fibrinogen alpha chain, and signaling proteins such as VEGF [32][33][34][35][36]. The majority of the research although so far is focused on nucleic biomarkers which include different types of miRNAs, mRNAs, long non-coding RNAs(lncRNAs), DNAs, and dd-cfDNA [37][38][39][40][41][42].…”