Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease

Qu, Junyan; Feng, Ping; Luo, Yukun; Lu, Xin-Jiang

doi:10.1097/md.0000000000004270

Cited by 25 publications

(26 citation statements)

References 35 publications

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“…Furthermore, elevated serum PCT levels have been reported to show pro-inflammatory effects and increase mortality rates in a sepsis model [5], while these effects are prevented via the inhibition of PCT expression [6]. Interestingly, serum PCT is also elevated in HBV-ACLF patients [7]. However, little is known about the correlation between serum PCT and renal dysfunction in HBV-ACLF patients.…”

Section: Introductionmentioning

confidence: 96%

“…HAV, HCV, HDV and HEV) and/ or human immunodeficiency virus; patients with a history of excessive alcohol consumption (> 40 g/day); patients with a history of liver allograft or malignancy such as hepatocellular carcinoma; and patients with signs of bacterial infection. Bacterial infection was diagnosed as described previously [7].…”

Section: Methodsmentioning

confidence: 99%

“…HBV-ACLF patients usually have elevated serum PCT levels even in the absence of infection [7]; however, the influence of elevated serum PCT on HBV-ACLF progression is not clear. Therefore, we focused on the correlation between serum PCT and renal function in HBV-ACLF patients.…”

Section: : Pct and Renal Function In Hbv-aclfmentioning

confidence: 99%

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Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Zheng

Liang

Shui

et al. 2018

Cell Physiol Biochem

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Background/Aims: To investigate the relationship between elevated serum procalcitonin (PCT) and renal function in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: HBV-ACLF patients (n = 201) presenting to the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, from January 2013 to November 2016 were categorized into three groups according to serum PCT levels: (i) normal group (n = 74) had PCT of ≤ 0.5 ng/mL; (ii) elevated group (n = 85) had PCT in the range 0.5–1.0 ng/mL; and (iii) highly elevated group (n = 42) had PCT of > 1.0 ng/mL. Thirty-five cases received standard care after admission. Serum PCT levels and renal function were determined during a two-week follow-up. Results: Significant increases in serum creatinine (Cr) were recorded in male and female patients in the elevated group and highly elevated group compared with the normal group (P < 0.05). In addition, serum Cr levels in male and female patients were significantly higher in the highly elevated group than in the elevated group (P < 0.05). The glomerular filtration rate (GFR) was significantly lower in the highly elevated group (P < 0.05) and this group had the highest risk of altered Cr (45.9% in males; 80% in females) and abnormal GFR (37.5%). Serum PCT levels correlated significantly with all renal function parameters including homocysteine (Hcy), GFR, Cr, blood urea nitrogen, uric acid, and cystatin C at baseline and during treatment. Univariate and multivariate analyses indicated that serum PCT was a strong predictor of renal dysfunction. Conclusion: Serum PCT is closely related to renal dysfunction in HBV-ACLF.

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Section: Introductionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

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Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Zheng

Liang

Shui

et al. 2018

Cell Physiol Biochem

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“…In our study, hepatic macrophages but not hepatocytes were found to be the cell source of hepatic PCT upregulation in ALF. Moreover, previous studies have shown that serum PCT is elevated in patients with ALF and ACLF [10,27,28], and the liver is one of the main sources of elevated serum PCT [7,29,30] in sepsis and cytokine storms. Thus, further study is required to clarify the involvement of hepatic PCT-especially that expressed by hepatic macrophages-in the elevation of serum PCT.…”

Section: Discussionmentioning

confidence: 99%

“…Acute liver failure (ALF) is a rapidly progressive and severe clinical syndrome that can induce dysfunction and failure in multiple organs [8]. It has been reported that the activation of Kupffer cells in the initial phase is involved in some intense inflammatory responses in the pathogenesis of ALF [9], and serum PCT is elevated in ALF patients [10]. The liver consists of parenchymal cells (hepatocytes) and nonparenchymal cells (Kupffer cells play an important role in inflammation).…”

Section: Introductionmentioning

confidence: 99%

Hepatic Macrophages are the Cell Source of Hepatic Procalcitonin in Acute Liver Failure

Zheng¹,

Ye²,

Xue³

et al. 2018

Cell Physiol Biochem

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Background/Aims: Serum procalcitonin (PCT) is elevated in acute liver failure (ALF), but the expression of PCT in the liver has not been elucidated. We aimed to clarify the regulation of hepatic PCT expression and the cell sources in ALF. Methods: Human monocytic leukemia line U937 cells were treated with 12-O-tetradecanoylphorbol-l3-acetate (PMA) (100 ng/ mL) for 24 h to induce activated macrophages. In the presence of lipopolysaccharide (LPS, 1 μg/mL), activated macrophages and human hepatocyte line L02 cells were incubated with LPS or co-cultured for 0, 2, 6, and 24 h. In an in vivo experiment, male C57BL/6 mice were challenged with intraperitoneal LPS/D-galactosamine (LPS/D-GalN). Serum liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using an automatic chemical analyzer. Inflammatory mediators were measured by real-time PCR and liver histology was examined by hematoxylin-eosin (HE) staining and immunohistochemistry (IHC). Results: LPS induced the upregulation of PCT mRNA in U937-activated macrophages but not in L02 cells. When co-cultured with L02 cells, the expression of PCT mRNA of activated macrophages was upregulated compared to controls; however, the activated macrophages did not induce the expression of PCT mRNA in L02 cells in the presence of LPS. Moreover, serum liver enzymes (ALT, AST), inflammation, necrosis, and hepatic expression of PCT were significantly elevated in the LPS/D-GalN-challenged ALF mouse model. IHC revealed that PCT expression was co-localized with hepatic macrophages. Conclusions: Hepatic PCT expression is upregulated in ALF. Hepatic macrophages but not hepatocytes are the cell source of hepatic PCT expression.

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Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

et al. 2021

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Background and Aims Acetaminophen is a common cause of poisoning and liver injury worldwide; however, patient stratification is suboptimal. We aimed to assess the contribution of admission plasma procalcitonin concentration (PCT) to better identify acetaminophen‐poisoned patients likely to develop liver injury. Methods We conducted a prospective observational cohort study including all acetaminophen‐poisoned patients requiring N‐acetylcysteine admitted in a toxicological intensive care unit between 2012 and 2017. Multivariate analysis was performed using a Cox regression model to investigate factors associated with liver injury, defined as an increase in alanine aminotransferase (ALT) >100 IU/L. Results One hundred seventeen patients (age, 32 years (21–53), median [25th–75th percentiles]) were included after self‐ingesting 16 g (9–30) acetaminophen and received N‐acetylcysteine infusion administered within a median 6 h‐delay (4–12) from exposure. Co‐ingestions were reported in 77% of patients. Rumack–Matthew nomogram was non‐interpretable in 47% cases. Liver injury occurred in 38 patients (32%) with a median peak ALT of 2020 IU/L (577–4248). In liver injury patients, admission PCT was significantly increased in comparison to patients without liver injury (21.5 ng/ml (3.2–44.9) versus 0.1 ng/ml (0–0.4), respectively, p < 0.01). The increase in PCT preceded the increase in ALT by 33 h (10–74). In a multivariate analysis, PCT > 1 ng/ml was significantly associated with liver injury (hazard ratio, 7.2 [95% confidence interval, 2.3–22.6; p < 0.001]). PCT (area under the receiver‐operating characteristics curve, 0.91 [95%CI: 0.84–0.97]) predicted liver injury with sensitivity, specificity, negative, and positive predictive values of 0.92, 0.84, 0.96, and 0.73, respectively. Conclusion PCT on admission is associated with liver injury in acetaminophen poisoning. PCT might be used as a predictive tool of liver injury to improve clinical decision‐making.

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Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease

Abstract: Supplemental Digital Content is available in the text

Cited by 25 publications

References 35 publications

Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Hepatic Macrophages are the Cell Source of Hepatic Procalcitonin in Acute Liver Failure

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

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