The Clinical Significance Of Serum Procalcitonin In Patients With Liver Failure

Objective: To investigate baseline PCT in liver failure patients without infections and explore the relationship between serum PCT and prognosis of patients with liver failure. To explore the clinical significance of serum PCT in diagnosis of bacterial infections in patients with liver failure.Methods: Retrospective cohort analysis was applied in studying the medical aspects of patients with liver failure(including liver failure without or with infections group) from February 2011 to December 2015. Patients diagnosed as liver cirrhosis without infections from January 2013 to December 2015 were divided into control group(liver cirrhosis without infection group), and the patients were divided into liver cirrhosis compensatory group and non compensatory group. The liver failure patients without infections were followed up, and the patients were divided into 2 groups including improvement group and non-survival group according to the prognosis of diseases. Data was analyzed by SPSS 18.0 software. Pearson or Spearman or Kendall correlation analysis was applied in studying the relationship between serum PCT and related indexes of liver failure. Repeated measures analysis of variance was applied in researching the prognostic value of serum PCT in liver failure patients without bacterial infection. The diagnostic accuracy of PCT for the diagnosis of bacterial infections was evaluated by measuring the area under the receiver operating characteristics curve(AUC) and by estimating the sensitivity and specificity. A P-value<0.05 indicated the difference was statistically significant.Results:(1) Comparison of baseline PCT: A total of 353 patients were enrolled including 86 cases of liver failure with infections, 106 cases of liver failure without infections and 113 decompensate liver cirrhosis patients, 48 compensated liver cirrhosis patients. The serum PCT baseline levels of liver failure with infections group [0.88(0.57-1.66)ng/m L] > liver failure without infections group [0.60(0.37-0.92)ng/m L] > liver cirrhosis non compensatory group [0.12(0.06-0.26)ng/m L] >liver cirrhosis compensatory group [0.05(0.05-0.10)ng/m L], the difference was statistically significant(P<0.05). The correlation between serum PCT and alanine aminotransferase(ALT), aspartate transaminase(AST) was the strongest, with the correlation coefficients of 0.350(P<0.001) and 0.302(P=0.002), respectively.(2) Prognostic judgment of PCT in liver failure: The baseline levels of PCT were not significantly different between improvement group and non-survival group in liver failure patients without infections(P>0.05). The levels of serum PCT in patients with better prognosis showed a significant downward trend with time, and the non-survival group showed a rising trend. However, the change of serum PCT between the groups and time points was of no significance, and the change trend of PCT with time was not affected by grouping(P>0.05).(3) Diagnostic value of serum PCT in diagnosing bacterial infections of liver failure patients: The levels of PCT were significantly different between liver failure without and with infections(P<0.05). The AUC for PCT in predicting bacterial infections in patients with liver failure were 0.658±0.040. The best threshold of serum PCT in diagnosis of bacterial infections in patents with liver failure was 1.08ng/m L, with the Youden’s index of 0.258. The sensitivity and specificity were 41.86%, 83.96%, respectively. The positive predictive value and negative predictive value were 66.67%, 63.77%, respectively. There were not significant differences of multiple comparisons between the four indexes(PCT, CRP, WBC and N%) of AUC(P > 0.05).Conclusion:(1) The baseline levels of serum PCT in liver failure patients without infections were higher than liver cirrhosis patients without infections. The levels of serum PCT reflected the liver damage in liver failure.(2) The value of serum PCT baseline levels in judging the prognosis of liver failure was limited. However, the dynamic monitoring changes of serum PCT might be important for the prognosis of liver failure.(3) The best threshold of serum PCT in diagnosis of bacterial infections in patients with liver failure was 1.08ng/m L. However, the diagnostic value of serum PCT on liver failure patients with bacterial infections was identical to the traditional markers of inflammation(CRP, WBC and N%).