Predictive Value of Procalcitonin for Bacterial Infection after Transarterial Chemoembolization or Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

This prospective observational study aimed at investigating the role of procalcitonin (PCT) in diagnosing bacterial infection and guiding antibiotic therapy for hepatocellular carcinoma (HCC) patients with fever after transarterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). Ninety-seven cases (84 patients) were enrolled. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured on the day of fever onset (day 0) and days 1, 3, 5, and 7 of fever. Empirical antibiotics were initiated only if PCT was ≥0.5 ng/mL or specific infection foci were suspected. An infectious cause was found in nine cases. PCT on day 0 of fever was significantly higher in patients with bacterial infection than in those without infection (P = 0.035). The area under the receiver operating characteristic curve for PCT was 0.715 (95% confidence interval, 0.538–0.892) and was higher than that for CRP (0.598 (0.368–0.828)) or WBC counts (0.502 (0.307–0.697)). In patients undergoing TACE and/or RFA, a significantly lower number of antibiotics were prescribed during the study period than during the prestudy period (P < 0.001). In conclusion, PCT might be a biomarker for diagnosing infection and guiding antibiotic treatment to reduce unnecessary antibiotic use in patients with fever after TACE and/or RFA.

Bacterial infections and fever after hepatocellular carcinoma ablation therapy: predictive role of procalcitonin

“…In the context of comparing the diagnostic accuracy of PCT and CRP in detection of bacterial infection in our cohort, the ROC curve revealed that PCT had higher sensitivity and specificity regarding prediction of bacterial infection with sensitivity of 100% and specificity of 100%, while CRP can predict bacterial infection with sensitivity of 90% and specificity of 92.5%, with significant area under the ROC curve for both of them; this agrees with many reports in the literature [ 19 - 24 , 26 - 28 ], which emphasizes the superiority of PCT over CRP regarding presence of bacterial infection in terms of higher sensitivity and specificity. Combining both PCT and CRP would have synergistic predictive value.…”

Prophylactic Use of Antibiotics for Postsurgical Infection in c-TACE and DEB-TACE High-Risk Patients: A Case-Control Study

“…TACE procedures have been regarded as minimally invasive with a good curative profile and strong repeatability; thus, it is mostly used in the nonsurgical treatment of HCC. However, the chance of occurrence of infection is always there, which results will not only prolong the hospital stay and expenses but also will affect the efficacy of treatment [ 13 ]. Moreover, the majority of the TACE-treated patients are middle-aged, or they are in the advanced stage of cancer where the immune system is less active, coupled with damage to nearby tissues caused by operation and the anticancer drugs' immune function inhibition leading to postoperative infection [ 14 , 15 ].…”