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Halder A, Liesenfeld O, Whitfield N, Uhle F, Schenz J, Mehrabi A, Schmitt FCF, Weigand MA, Decker SO. A 29-mRNA host-response classifier identifies bacterial infections following liver transplantation - a pilot study. Langenbecks Arch Surg 2024; 409:185. [PMID: 38865015 PMCID: PMC11169022 DOI: 10.1007/s00423-024-03373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/01/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Infections are common complications in patients following liver transplantation (LTX). The early diagnosis and prognosis of these infections is an unmet medical need even when using routine biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT). Therefore, new approaches are necessary. METHODS In a prospective, observational pilot study, we monitored 30 consecutive patients daily between days 0 and 13 following LTX using the 29-mRNA host classifier IMX-BVN-3b that determine the likelihood of bacterial infections and viral infections. True infection status was determined using clinical adjudication. Results were compared to the accuracy of CRP and PCT for patients with and without bacterial infection due to clinical adjudication. RESULTS Clinical adjudication confirmed bacterial infections in 10 and fungal infections in 2 patients. 20 patients stayed non-infected until day 13 post-LTX. IMX-BVN-3b bacterial scores were increased directly following LTX and decreased until day four in all patients. Bacterial IMX-BVN-3b scores detected bacterial infections in 9 out of 10 patients. PCT concentrations did not differ between patients with or without bacterial, whereas CRP was elevated in all patients with significantly higher levels in patients with bacterial infections. CONCLUSION The 29-mRNA host classifier IMX-BVN-3b identified bacterial infections in post-LTX patients and did so earlier than routine biomarkers. While our pilot study holds promise future studies will determine whether these classifiers may help to identify post-LTX infections earlier and improve patient management. CLINICAL TRIAL NOTATION German Clinical Trials Register: DRKS00023236, Registered 07 October 2020, https://drks.de/search/en/trial/DRKS00023236.
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Affiliation(s)
- Amelie Halder
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | | | | | - Florian Uhle
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Judith Schenz
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Arianeb Mehrabi
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral & Transplantation Surgery, Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Felix C F Schmitt
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Sebastian O Decker
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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You P, Gao RY, Han YZ, Zhang XK, Li WX, Huang LF. Diagnostic Accuracy of Procalcitonin for Infection After Adult Liver Transplantation: A Meta-Analysis and Systematic Review. Surg Infect (Larchmt) 2023; 24:763-772. [PMID: 37944095 DOI: 10.1089/sur.2023.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Post-operative infection remains a major cause of morbidity and mortality in adults early after liver transplantation (LT). Procalcitonin (PCT) may be a good test method for early diagnosis of post-operative infection and determining its severity. This study was performed to assess the diagnostic accuracy of PCT as a biomarker for infection after LT. Patients and Methods: A meta-analysis and systematic review was conducted for studies reporting diagnostic performance of PCT for infection in adults after LT. Observational studies were evaluated for their reporting of diagnostic accuracy, relevance, and quality. Results: Ten eligible studies assessing 730 patients were included in this meta-analysis and systematic review summarizing the diagnostic value of PCT for post-operative infection in adult liver transplantation. Pooled sensitivity and specificity with corresponding 95% confidence interval were 69% (95% confidence interval [CI], 54-81; heterogeneity I2 = 82.4%) and 88% (95% CI, 82-92; I2 = 52.7%), respectively. The diagnostic odd ratio (DOR) was 16 (95% CI, 10-25; I2 = 76.4%). The summary receiver operator characteristic (SROC) of PCT for post-operative infection was 0.88. There was a wide range of variability in the cutoff values, ranging from 0.22 to 42.80 ng/mL. Heterogeneity was reduced by excluding studies that focused on pediatric LT recipients. Conclusions: Procalcitonin is a moderately accurate diagnostic marker for post-operative infection in adult LT. Additionally, the diagnostic performance can be improved by combining it with other inflammatory biomarkers. This article provides the research direction for post-operative infection control.
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Affiliation(s)
- Pan You
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Rong-Yue Gao
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Yu-Zhen Han
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Xiao-Ke Zhang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Wen-Xiong Li
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Li-Feng Huang
- Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
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Frick K, Beller EA, Kalisvaart M, Dutkowski P, Schüpbach RA, Klinzing S. Procalcitonin in early allograft dysfunction after orthotopic liver transplantation: a retrospective single centre study. BMC Gastroenterol 2022; 22:404. [PMID: 36045337 PMCID: PMC9429388 DOI: 10.1186/s12876-022-02486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Ischemia–reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT. Methods Patients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed. Results Of 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7–53.8) mcg/l vs. 11.1 (5.3–25.0) mcg/l; p < 0.001 and 27.7 (9.7–51.9) mcg/l vs. 11.5 (5.5–25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD. Conclusion Generally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02486-5.
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Decker SO, Krüger A, Wilk H, Uhle F, Bruckner T, Hofer S, Weigand MA, Brenner T, Zivkovic AR. Concurrent Change in Serum Cholinesterase Activity and Midregional-Proadrennomedullin Level Could Predict Patient Outcome following Liver Transplantation. Biomolecules 2022; 12:biom12070989. [PMID: 35883545 PMCID: PMC9312899 DOI: 10.3390/biom12070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Background: After liver transplantation (LTX), patients are susceptible to opportunistic infections resulting in reduced outcomes within the early post-transplantation period. The postoperative monitoring of LTX patients has gained much importance in recent years. However, reliable plasmatic markers predicting 90-day outcomes are still lacking. Methods: In the post hoc analysis of a prospective, observational study, butyrylcholinesterase (BChE), mid-regional proadrenomedullin (MR-proADM), as well as conventional inflammatory markers (procalcitonin, C-reactive protein) were evaluated in 93 patients at seven consecutive timepoints within the first 28 days following LTX. Results: Persistently reduced activity of BChE and elevated MR-proADM levels indicated reduced 90-day survival following LTX. Furthermore, reduced BChE and increased MR-proADM activity could indicate early post-transplantation bacterial infections, whereas conventional inflammatory biomarkers showed no diagnostic efficacy within the observation period. Conclusion: Concurrent assessment of BChE and MR-proADM activity might serve as a bedside diagnostic tool for early bacterial infections following liver transplantation. Thus, a combined utilization of the two biomarkers may be a useful tool in the risk evaluation of patients following liver transplantation.
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Affiliation(s)
- Sebastian O. Decker
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Correspondence: (S.O.D.); (A.R.Z.); Tel.: +49-(0)62-215636380 (S.O.D.); +49-(0)62-215636843 (A.R.Z.); Fax: +49-(0)62-21565345 (S.O.D. & A.R.Z.)
| | - Albert Krüger
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Henryk Wilk
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany;
| | - Stefan Hofer
- Department of Anesthesiology, Westpfalzklinikum, Kaiserslautern, Hellmut-Hartert-Straße 1, 67655 Kaiserslautern, Germany;
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Aleksandar R. Zivkovic
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Correspondence: (S.O.D.); (A.R.Z.); Tel.: +49-(0)62-215636380 (S.O.D.); +49-(0)62-215636843 (A.R.Z.); Fax: +49-(0)62-21565345 (S.O.D. & A.R.Z.)
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Nuzzo A, Salem S, Malissin I, Diallo A, Deye N, Goury A, Gourlain H, Péron N, Vicaut E, Voicu S, Mégarbane B. Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study. United European Gastroenterol J 2021; 9:571-580. [PMID: 34181312 PMCID: PMC8259278 DOI: 10.1002/ueg2.12093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 01/16/2023] Open
Abstract
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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Affiliation(s)
- Alexandre Nuzzo
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France.,Department of Gastroenterology, APHP, Beaujon Hospital, Paris University, INSERM UMRS-1148, Clichy, France
| | - Shireen Salem
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Abdourahmane Diallo
- Department of Epidemiology, APHP, Biostatistics and Clinical Research, Fernand-Widal Hospital, Paris University, Paris, France
| | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Antoine Goury
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Hervé Gourlain
- APHP, Laboratory of Toxicology, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Nicolas Péron
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Eric Vicaut
- Department of Epidemiology, APHP, Biostatistics and Clinical Research, Fernand-Widal Hospital, Paris University, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
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Applicability of common inflammatory markers in diagnosing infections in early period after liver transplantation in intensive care setting. Sci Rep 2020; 10:3918. [PMID: 32127631 PMCID: PMC7054413 DOI: 10.1038/s41598-020-60936-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
Infections remain an important cause of morbidity and mortality early after liver transplantation. The aim of this prospective longitudinal study was to evaluate clinical utility of c-reactive protein (CRP), procalcitonin, and neutrophil-to-lymphocyte ratio (NLR) in surveillance of infections early after liver transplantation in intensive care setting. A total of 60 liver transplant recipients were included. CRP, procalcitonin, and NLR assessed at 12-hour intervals were primary variables of interest. Infections and severe complications during postoperative intensive care unit stay were the primary and secondary end-points, respectively. Infections and severe complications were diagnosed in 9 and 17 patients, respectively. Only peak CRP beyond first 48 hours was associated with infections (p = 0.038) with AUC, positive and negative predictive value of 0.728, 42.9% and 92.2%, respectively (cut-off: 142.7 mg/L). Peak procalcitonin over first 60 hours was the earliest predictor (p = 0.050) of severe complications with AUC, positive and negative predictive value of 0.640, 53.3% and 80.0%, respectively (cut-off: 42.8 ng/mL). In conclusion, while CRP, procalcitonin, and NLR cannot be used for accurate diagnosis of infections immediately after liver transplantation, peak CRP beyond 48 hours and peak procalcitonin over first 60 hours may be used for initial exclusion of infections and prediction of severe complications, respectively.
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Xiao H, Zhang P, Xiao Y, Xiao H, Ma M, Lin C, Luo J, Quan H, Tao K, Huang G. Diagnostic accuracy of procalcitonin as an early predictor of infection after radical gastrectomy for gastric cancer: A prospective bicenter cohort study. Int J Surg 2020; 75:3-10. [PMID: 31978647 DOI: 10.1016/j.ijsu.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of procalcitonin (PCT) as an early predictor of infection following radical gastrectomy to treat gastric cancer (GC). METHODS A prospective, observational, cohort study was conducted in two high-volume tertiary centers (registered under ClinicalTrials.gov). A total of 552 consecutive adult patients undergoing radical gastrectomy for GC from June 2018 to July 2019 were included. Routine blood tests (white blood cell count (WBC); neutrophil count; the neutrophil:WBC ratio, N%) and PCT were measured on post-operative day (POD) 3 and 5. Post-operative infection was recorded based on the criteria of the Center for Disease Control. The area under the curve (AUC) summarizing receiver-operating characteristic was calculated and compared for each biomarker measured. RESULTS Ninety three adverse events occurred in 70 patients (12.7%), with infections being the most common (n = 37, 6.7%). With cutoff values of 0.695 ng/mL at POD 3 and 0.515 ng/mL at POD 5, specificity and negative predictive value for infections were 0.656 and 96.3%, 0.816 and 96.1%, respectively. PCT had a better AUC than the WBC and neutrophil count to detect post-operative complications, especially infections (AUC: 0.678, 0.600, 0.592, P = 0.028 and 0.017, respectively) at POD 3, but which were comparable at POD 5. Additionally, 4 of the 8 patients with PCT levels ≥3 ng/mL on POD 5 were confirmed to have an infection. CONCLUSION PCT is a more reliable predictor than WBC and neutrophil count to detect infections following radical gastrectomy for GC. PCT levels <0.695 ng/mL at POD 3 and < 0.515 ng/mL at POD 5 makes post-operative infections very unlikely but extreme high PCT levels should alert the surgeon to the possibility of infections.
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Affiliation(s)
- Hua Xiao
- Department of Gastrointestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanping Xiao
- Department of Admissions and Employment, Changsha Health Vocational Colllege, Changsha, China
| | - Haifan Xiao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Min Ma
- Postdoctoral Research Station of Clinical Medicine, The Third Xiangya Hospital of Central South University, Changsha, China; Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Changwei Lin
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Luo
- Department of Gastrointestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hu Quan
- Department of Gastrointestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Gang Huang
- Department of Gastrointestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; Department of Orthopedics, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
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Positive Role of Procalcitonin Level in the Diagnosis of Infectious Diseases After Liver Transplantation. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.85668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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9
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Dulek DE, Mueller NJ. Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13545. [PMID: 30900275 PMCID: PMC7162188 DOI: 10.1111/ctr.13545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022]
Abstract
These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation, empirical therapy may be initiated under close clinical observation. In all other patients, or those not responding to the initial therapy, a more aggressive diagnostic approach including sampling of tissue for microbiological and pathological testing is warranted. Given the broad range of potential pathogens, a microbiological diagnosis is often key for optimal care. Given the limited literature comparatively evaluating diagnostic approaches to pneumonia in the solid organ transplant recipient, much of the proposed diagnostic algorithm reflects clinical experience rather than evidence-based data. It should serve as a template which may be modified according to local needs. The same holds true for the suggested empiric therapies, which need to be adapted to the local resistance patterns. Further study is needed to comparatively evaluate diagnostic and empiric treatment strategies in SOT recipients.
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Affiliation(s)
- Daniel E Dulek
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zürich, Switzerland
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Dong R, Wan B, Lin S, Wang M, Huang J, Wu Y, Wu Y, Zhang N, Zhu Y. Procalcitonin and Liver Disease: A Literature Review. J Clin Transl Hepatol 2019; 7:51-55. [PMID: 30944820 PMCID: PMC6441648 DOI: 10.14218/jcth.2018.00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/02/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022] Open
Abstract
Procalcitonin (PCT) is a widely used biomarker for the diagnosis of bacterial infections. It is produced by various organs and the liver is considered to be the most important site of production. Severe liver dysfunction has been shown to influence PCT levels. Patients with no sources of infection who have liver disease are observed to have increased serum levels of PCT, thereby reducing the diagnostic utility and value within this particular patient subset. Here, we have summarized the relationship between PCT and liver disease, including liver cirrhosis, liver failure, and liver transplantation.
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Affiliation(s)
- Ruolin Dong
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bo Wan
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Su Lin
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mingfang Wang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiaofeng Huang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yinlian Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yilong Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Nanwen Zhang
- Department of Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Yueyong Zhu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence to: Yueyong Zhu, Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China. Tel: +86-591-87981660, Fax: +86-591-83356180, E-mail:
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Bobillo-Perez S, Rodríguez-Fanjul J, Jordan Garcia I. Is Procalcitonin Useful in Pediatric Critical Care Patients? Biomark Insights 2018; 13:1177271918792244. [PMID: 30093797 PMCID: PMC6081751 DOI: 10.1177/1177271918792244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
This review examines the use of procalcitonin in different clinical situations in the pediatric patient, with special emphasis on those requiring intensive care. We review the latest articles on its potency as a biomarker in both infectious processes at diagnosis and on the response to treatment.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit Service, Research Group of the Pediatric Critical Patient, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan Garcia
- Pediatric Intensive Care Unit, Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
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Ding X, Yang D, Ke C, Gong L, Zhan H, Yan R, Chen Y, Li H, Wang J. Value of evaluating procalcitonin kinetics in diagnosis of infections in patients undergoing laparoscopic radical cystectomy. Medicine (Baltimore) 2017; 96:e8152. [PMID: 29049197 PMCID: PMC5662363 DOI: 10.1097/md.0000000000008152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Postsurgery infection is a common complication after laparoscopic radical cystectomy (LRC) followed by urinary diversion. White blood cell (WBC) values and C-reactive protein (CRP) are routinely used as markers for infection, but lack of specificity and their elevation is often delayed in clinically significant events. In this study, we aimed to investigate the value of procalcitonin (PCT) kinetics in assisting early diagnosis of infection in patients undergoing LRC.The patients' medical records between May 2013 and May 2016 were reviewed retrospectively. WBC, CRP, and PCT plasma levels as well as clinical symptoms were registered in 306 patients preoperatively (day 0), and 5 consecutive days postoperatively. Based on microbiological and clinical data, patients were grouped into noninfection- (NI-) and infection- (I-) groups. The day of new onset infection was observed were defined as day t0 and the day after that as day t1. For the NI-group, the day on which PCT was at the peak was defined as day t1 and the previous day as day t0.Of the 306 patients, 46 (15.03%) have proven infection. PCT levels were analogous at day t0:NI-group [median (interquartile range)]: 0.69(1.99) vs I-group [median (interquartile range)]: 1.0[0.75], P = .1. PCT levels were significantly increased at day t1 in the I-group[median (interquartile range)]:2.9(1.3) vs NI-group[median (interquartile range)]: 1.3(1.5), P < .01. The area under the curve for the prediction of infection was 0.72 [95% confidence interval (CI) = 0.63-0.81] for the absolute value of PCT; and for delta PCT:0.88 (95% CI = 0.81-0.94), P < .01. The optimal cut-off value was 0.79 ng/mL with the highest Youden index of 0.80 for delta-PCT to indicate infection. Neither absolute values nor changes in CRP, or WBC could predict infection better. The "delta" was considered as the changes in the absolute values (subtracting day t0 from day t1) of PCT, CRP, and WBC.This study suggest that early elevation of PCT within the first 24 hours of new onset infection, interpreted with clinical results, appears to be a promising indicator for the diagnosis of infections following LRC.
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Affiliation(s)
- Xiangli Ding
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
| | - Delin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
| | - Changxing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
| | - Long Gong
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baoding, Hebei
| | - Hui Zhan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
| | - Ruping Yan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
| | - Yan Chen
- Department of Obstetrical, The Second Affiliated Hospital of Kunming Medical University
| | - Haiyuan Li
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan
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