Abstract :
Background & Aims: Systemic inflammatory response syndrome (SIRS) caused by overt or occult bac-
terial infection is often present in patients with advanced cirrhosis with an associated negative outcome. Procalcitonin
(PCT), a calcitonin precursor, seems to be the most promising biomarker to diagnose sepsis and predict mortality in
this population. We conducted a prospective observational study to evaluate the diagnostic and prognostic values of
serial measurement of plasma PCT levels in cirrhotic patients presented with SIRS.
Methods: This study was conducted between March 2012 and January 2013 at a tertiary academic medi-
cal center. All patients were managed in accordance with standard care by a multidisciplinary team. Serum PCT
level was measured by the electrochemiluminescence immunoassay (Elecsys BRAHMS PCT, Cobas, ROCHE) at
baseline, 24 hours and 72 hours after admission. The clinical outcomes were the presence of infection and in-
hospital mortality.
Results: Our preliminary data was taken from 29 cirrhotic patients with SIRS. The mean age was 60 ±
11.7 years, and 72% were male. Most patients had severe liver disease on admission, with a mean model of end-
stage liver disease score of 21.8 ± 8.5, 69% with Child-Pugh class C. Twenty-three patients (79%) with SIRS had
obvious infection at the following sites: spontaneous bacterial peritonitis (44.8%), respiratory infections (10.3%),
isolated bacteremia (6.9%), and others (17%). On admission the median PCT levels were significantly higher in
patients with sepsis in comparison to patients with SIRS (4.5 vs. 1.28 ng/mL, p = 0.046). In patients with sepsis, the
maximum values for PCT were noted at admission, and declined gradually. Eleven patients died during hospitaliza-
tion (37.9%), 10 of whom had an obvious infection. The median PCT levels during the first 72 hours of admission
were significantly higher in the non-survivor group compared with the survivor group. Conclusions: This study
showed that PCT levels were of value in differentiating between sepsis and SIRS in cirrhotic patients, particularly
at admission, this biomarker can help predict in-hospital mortality. |
file/Thai-Journal-of-gastroenterology-vol-15-no-1-2030313.pdf