Changes in Sepsis Biomarkers after Immunosuppressant Administration in Transplant Patients

Abstract

Sepsis biomarkers change continuously during the postoperative period. We aimed to demonstrate the influence of immunosuppressants after transplantation (Tx) on presepsin, procalcitonin, CRP, white blood cells, and IL-6. A group of 140 patients after major surgery (86 non-Tx, 54 Tx) without any signs of sepsis or infectious complications was followed for 7 days. The changes in biomarkers were analyzed with respect to the type of surgery, organ, and induction immunosuppressant used (antithymocyte globulin, corticosteroids, or basiliximab/rituximab). Concentrations (95th percentiles) of presepsin and procalcitonin were higher in the Tx group (presepsin: Tx < 2380 vs. non ‐ Tx < 1368 ng / L , p < 0.05 ; procalcitonin: <28.0 vs. 3.49 μg/L, p < 0.05 ). In contrast, CRP and IL-6 were lower in the Tx group (CRP: Tx < 84.2 vs. non ‐ Tx < 229 mg / L , p < 0.05 ; IL-6: <71.2 vs. 317 ng/L, p < 0.05 ). Decreases in CRP and IL-6 were found for all immunosuppressants, and procalcitonin was increased after antithymocyte globulin and corticosteroids. Negligible changes were found for white blood cells. Different responses of presepsin, procalcitonin, CRP, and IL-6 were therefore found in patients without any infectious complications after major surgery or transplantation. Immunosuppression decreased significantly IL-6 and CRP in comparison to non-Tx patients, while procalcitonin was increased after corticosteroids and antithymocyte globulin only. Cautious interpretation of sepsis biomarkers is needed in the early posttransplant period. This work was conducted as a noninterventional (nonregistered) study.

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review

“…We reviewed 15 research papers with a total of 3,484 postoperative patients. Out of these finalized studies, two were systematic reviews and meta-analyses [21,22], two were narrative reviews [23,24], one was a nonrandomized clinical trial, and the remaining nine were observational studies [10][11][12][13][14][15][16][17][18][19], and one nonrandomized interventional study [20]. All studies involved operated patients and the measurement of CRP and PCT postoperatively during their in-hospital/ICU stay and their role in patients developing sepsis and SIRS.…”

“…Another observational study by Franeková et al involved 140 postoperative patients who underwent abdominal surgery, transplant, or major cardiac surgery. They divided the groups into two subsets, one undergoing major abdominal or cardiac surgeries and the other undergoing transplant [ 12 ]. The patients undergoing major abdominal and cardiac surgeries in the first subset showed elevated levels of biomarkers.…”

“…The transplant patients were the treatment group and were given immunosuppressants. No infections were observed in the first week, all patients survived the first month, and none developed sepsis [ 12 ]. In post-transplant patients receiving immunosuppressants, CRP levels were lower.…”

“…In post-transplant patients receiving immunosuppressants, CRP levels were lower. PCT, however, was still higher in response to surgical stress [ 12 ].…”

Insight Into Regulatory T Cells in Sepsis-Associated Encephalopathy

“…The systemic immune-inflammation/cytokine storm, which constitutes an exaggerated host immune response associated with excessive production of pro-inflammatory cytokines, chemokines and acute phase proteins, is a hallmark feature in the acute phase of sepsis (18,(64)(65)(66)(67)(68)(69)(70)(71). This is one of the main causes of death and ICU acquired complications, including SIRS and compensatory anti-inflammatory response syndrome (CARS), and is defined by the host status (57,(72)(73)(74)(75)(76), pathogens (77,78) and the time span of sepsis (71,(79)(80)(81)(82)(83)(84). T regs have been shown to have a role on the inhibition of sepsis-induced amplifying systemic immuno-inflammation/cytokine storm and on the protection of organs in the early stage of sepsis (53,85,86).…”