The Diagnostic Value Of Serum Procalcitonin In Patients With Liver Failure

Objective: To investigate the serum procalcitonin levels and compare the diagnosticvalue of serum PCT and traditional infalmmatory biomarkers(CRP, WBC, N%) indiagnosis of bacterial infections in patients with liver failure.Methods: A retrospective cohort study was conducted involving patients with liverfailure(including liver failure with or without infection group), hepatic cirrhosispatients without infection(hepatic cirrhosis group) from October2010to February2014. Suspicious sepsis value and healthy population reference value were defined as0.05ng/ml and0.5ng/ml.Serum PCT and traditional inflammatory biomarkersincluding WBC, CRP, N%were analyzed to compare their diagnostic value in bacterialinfections in patients with liver failure, and a best threshold of PCT for diagnosis ofbacterial infections in liver failure was determined. All analyses were conducted bySPSS17.0and a p-value <0.05was considered significant.Results: A total of146cases were enrolled including106cases of liver failure (59with infection and47without),40cases of hepatic cirrhosis without infection. Theserum PCT of group was0.48±0.22ng/ml,2.11±3.11ng/ml and0.17±0.09ng/ml,resectively. The serum PCT of liver failure without infection group> hepatic cirrhosisgroup> healthy population reference values, the difference was statistically significant(P <0.05); liver failure with infection group> suspicious sepsis value, the differencewas statistically significant (P <0.05).The serum PCT of suspicious sepsis value>hepatic cirrhosis group, the difference was statistically significant (P <0.05); thedifference between liver failure without infection group and suspicious sepsis valuewas not statistical different. The serum PCT, CRP, WBC and N%of liver failurewithout and with infection group were statistical different (P <0.05). The area undercurve for PCT, CRP, WBC and N%in predicting bacterial infections in patients with liver failure were0.928±0.026,0.747±0.047,0.647±0.05and0.747±0.047,respectively. AUC for PCT was significantly higher than CRP, WBC and N%(P <0.05). The best threshold of PCT in diagnosis of bacterial infection in paitents withliver failure was0.6ng/ml, with a sensitivity of93.22%and a specificity of82.98%.The positive(PPV) and negative predictive value(NPV) were87.3%,90.7%; thepositive and negative likelihood ratio were5.48,0.082; and the Youden’s index was0.762.Conclusion:(1)The serum PCT levels in liver failure or liver cirrhosis patients withoutinfection were higher than healthy population.(2)PCT, with the best threshold of0.6ng/ml, performed favorably in diagnosing of bacterial infections in patients with liverfailure comparing with traditionally biomarkers(CRP, WBC, N%).