Evaluation of procalcitonin (PCT) as a marker of infection in early post living donated liver transplant period

Abstract

Background: 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 aim is to assess the frequency of rising procalcitonin 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 are analyzed till discharge from intensive care unit.Results: Sixty patients were classi ed according to the culture results' into a positive culture group & a negative one, then following up sepsis variables in each group. Total leukocyte count (TLC) and procalcitonin (PCT) were high in the positive culture group in the rst 4 and 5 days respectively and was statistically signi cant (P-value < 0.05).PCT at a cutoff value ≥ 9ng/ml had higher speci city, especially on day three postoperative (90.7%). The TLC cutoff value of ≥ 17.3/mm 3 on day one; had the speci city of > 90%.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.

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.…”

“…Table 4 shows the number of participants and the identified variables from the finalized studies. A retrospective observational study involving 60 postoperative liver transplant patients admitted to the ICU was conducted to determine the association between increased levels of PCT and infection and related complications in immunosuppressed patients [11]. They also explored non-infectious causes of the transplant.…”

“…Considering CRP as an acute phase reactant, it reached its peak on the third postoperative day and then was lowered by the fifth day. PCT is a good marker to detect inflammation early; however, in postoperative patients, it may be affected by factors such as immunosuppression, surgical procedures, underlying conditions, and comorbidities [ 11 ]. Therefore, PCT in the first few days of surgery can serve as a guide to initiate early antibiotic therapy in high-risk patients.…”

Current state of antimicrobial stewardship in solid organ transplantation in Israel

“…19 Although most studies excluded immunocompromised patients, 19 several studies have shown that the performance of procalcitonin is not compromised in SOT recipients, and that it may serve as a useful adjunct in ruling out bacterial infections in this population, thus avoiding unnecessary antibiotic use. 20,21 Allergy testing in patients with reported antibiotic allergies is a recommended stewardship activity. 2 In a study by Khumra et al, antibiotic allergies, particularly to sulfonamides and beta-lactams, were commonly reported in liver transplant recipients (16%).…”