Diagnostic Value Of Different Inflammatory Response Indicators In Different Period Of Chronic Liver Disease With Bacterial Infection

Objective:To investigate the diagnostic value of WBC,N%,CRP,PCT,IL-6 in patients in chronic liver disease with bacterial infection.Methods:This study retrospectively collected clinical data of patients with chronic liver disease who were admitted to the Liver Research Center of the First Affiliated Hospital of Fujian Medical University from 2013 to 2016.Patients with chronic liver disease include chronic viral hepatitis,hepatolenticular degeneration,autoimmune liver disease,liver cirrhosis,liver failure,and liver malignancy..Patients were classified into non-infective and infection groups according to bacterial infection.White blood cell count(WBC),neutrophil percentage(N%),IL-6,PCT,CRP levels were collected.Infected patients were divided into two groups according to the time for blood sampling,which were within 6 hours of fever and 6 hours after fever onset.The diagnostic value of each index were analyzed by the receiver operating characteristic(ROC)curve.Results:A total of 700 patients with chronic liver disease were enrolled with 246patients in the non-infected group and 454 patients in infected group.Among them,355 were infected within 6 hours of fever and 99 were taken 6 hours after fever onset.The median WBC level was 5.42 x 10~9/L,the median N%was 66.00%,the median CRP was 14.72 mg/L,and the median PCT was 0.20 ng/ml in non-infected group.The median level of IL-6 was 23.24 pg/ml,which was respectively lower than 6.74×10~9/L,77.80%,35.14 mg/L,0.61 ng/ml,and 91.23pg/ml in infection group.The differences between two groups were all statistically significant(P<0.01).The area under the ROC curve(AUC)for IL-6 within 6hours of infection was 0.893(95%CI:0.851 to 0.926),which was higher than N%(0.780)and CRP(0.687)(Z values were 3.607,6.160,all P<0.05).The thresh-old of IL-6 for diagnosis bacterial infection was 57.38 pg/mL with a sensitivity of 84.63%,a specificity of 79%,a positive predictive value of 64.7%within 6 hours of fever.After 6 hours of fever,the AUC of PCT was 0.676(95%CI:0.633 to 0.717),which was higher than that of IL-6(0.652)and CRP(0.650),but the difference was not statistically significant(Average P>0.05).Conclusions:1.1.The levels of CRP,PCT,and IL-6 in patients with chronic liver disease with bacterial infection are higher than those without infection.The difference is statistically significant.2.In the early stage of infection(within 6 hours of fever),serum IL-6 was better than WBC,N%,CRP,PCT in the diagnosis of chronic liver disease with bacterial infection.Therefore,IL-6 can be used as an early marker of infection.3.In the later stages of infection(6 hours after fever onset),the diagnostic value of serum PCT for chronic liver disease with bacterial infection is similar to other inflammatory markers(IL-6,CRP,WBC,N%)...