Clinical Application Of Procalcitonin In Catheter-Related Bloodstream Infection

Objective.The aim was to investigated the role of procalcitonin(PCT)for early detection or exclusion of central venous catheter–related bloodstream infections(CRBSI)in patients with end stage liver disease after liver transplantation(LT).Methods.40 patients with end stage liver disease who underwent orthotopic liver transplantation were collected at organ transplantation center of Tianjin First Central Hospital.Fifty-five transplanted patients with clinically suspected CRBSI were assessed after liver transplantation in this prospective study.The peripheral blood leukocyte,c-reactive protein(CRP),and PCT levels were dynamicly detected underwent perioperative.Plasma PCT and(1,3){beta}-D-glucan(BG)values were measured by using an immunoluminometric assay and dynamic colorimetric assay,respectively.Statistical analysis was performed using SPSS 16.0 software.To evaluate differences between the groups,we Student t test or Mann-Whitney U test as appropriate.To compare the value of PCT and BG to diagnose CRBSI,we performed a receiver operating characteristic(ROC)curve analysis.Data were expressed as area under ROC curves.A P value <0.05 was considered to be statistically significant.Result.1.The average WBC count,CRP and PCT concentration of patients with uncomplicated liver transplantation were significantly increased on the 1st to 3rd day after liver transplantation.Over time,the levels of WBC,PCT,and CRP were gradually decreased,and returned to normal 7 to 10 days after liver transplantation in peripheral blood.2.The PCT values were significantly higher in CRBSI than in non-CRBSI patients(P <0.01).CRBSI patients did not show significant increases in plasma BG values compared with non-CRBSI subjects(P>0.05).Among the 24 patients with bacteria infections,PCT levels were significantly higher in patients with gram-negative than those with gram-positive bacterial infections,the difference was statistically significant(P<0.05).BG levels were higher in patients with gram-negative than those with gram-positive bacterial infections,he difference was statistically significant(P<0.05).3.The ROC curve was examined by CRBSI group and non-CRBSI group,the PCT and BG area under receiver operating characteristic curves were 0.838(0.728-0.949,P<0.01)and 0.612(0.453-0.771,P>0.05),respectively.4.Sensitivity,specificity,and positive and negative predictive values of PCT for the diagnosis of CRBSI were 71%,87%,81%,and 79%,respectively.5.The peripheral blood PCT level in patients after antibiotic treatment was significantly lower than that before treatment,and the differences were statistically significant(P<0.05).Conclusion.PCT has clinical value in the early diagnosis,differential diagnosis and prognosis evaluation of CRBSI after liver transplantation.