The Clinical Value Of Serum Procalcitonin And Its Clearance Rate For Infection Diagnostics And Prognostic In Liver Transplant Recipients After Liver Transplantation

Objective: Analyzed changes of procalcitonin(PCT)and procalcitonin clearance rate(PCTC)in patient with different outcomes after liver transplantation.Methods:A prospective observational study was conducted in adult ICU.A total of 32 patients admitted into our ICU after liver transplantation from October 2015 to june 2017 were included in this study,patients were divided into in infection group and non-infection group.The serum PCT and its clearance rate had been recorded in both group daily.The APACHE-II scores were estimated within 24 hour in each group.The diagnostic and predictive performance of PCT,PCTC and APACHE-II scores were assessed by the receiver operating characteristic curve(ROC).Results:The serum PCT value of the third,the fifth,the seventh and the ninth day after transplantation between infection and non-infection group were [ 13.27(6.25~26.85)] and [ 5.69(5.21~14.25)],[20.57(15.65~35.25)] and [ 5.65(4.72~13.65)],[ 30.31(22.21~50.36)] and [ 6.47(0.94~9.25)]n g/mL,which all had statistical significance(Z =-2.166,-3.305,-3.400,-3.873,P all<0.05),PCT was gradually decreased in non-infection group,while remained at higher level in infection group,which was significantly lowered at 5 days after 5th postoperative day in non-infection group compared with that in the infection group.The median PCTC of the seventh and ninth day after transplantation between infection group and non-infection group were-195%(-548%~-70%)and-23%(-93%~55%),-223%(-645%~-89%)and-39%(-96%~89%),which all had statistical significance(Z =-3.001,-3.153,p all <0.05).the areas under the ROC curve of the the fifth,the seventh and the ninth day after transplantation were 0.708(95%CI:0.517-0.900,P=0.046)?0.778(95%CI:0.614-0.942,P=0.008)? 0.813(95 % CI:0.665-0.962,P=0.003)? 0.829(95 %CI:0.689-0.97,P=0.002),When PCTC-9 Was-78.04%,the sensitivity was 85.7% and the specificity was 73.4%.Conclusion:The increased levels of PCT in patients after liver transplantation were associated the poor control of infection and may indicate the deterioration of infection,it also can reflect the activity of infection in time.Keep observing the dynamic change of PCT and analyzing PCTC is more useful.The PCTC levels may provide evidence of disease progression and helpful in risk stratification and lower level of PCTC may accompany serious infection and predict poor prognosis or mortality.