Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Liver Transpl. 2010 Mar;16(3):402-10. doi: 10.1002/lt.21987.
Clinically significant infections (CSIs) are life-threatening but difficult to diagnose after liver transplantation (LTx). This study investigates the value of procalcitonin (PCT) in addition to c-reactive protein (CRP) and the leukocyte count (LC) as a prognostic marker for CSIs in LTx recipients. The clinical course of 135 LTx recipients was prospectively studied. CSIs were defined as pulmonary, bloodstream, or intra-abdominal infections. Independent risk factors for CSIs were determined by Cox proportional hazard analysis. The concordance statistics (c-statistics) were used to assess the discrimination effect of PCT. Thirty recipients (22%) experienced a CSI. They had significantly higher peak PCT (27.2 versus 12.7 ng/mL, P = 0.014) and peak CRP (13.7 versus 9.9 mg/dL, P < 0.001) and a tendency toward a higher peak LC (19.3 versus 14.2 cells/nL, P = 0.051) in comparison with recipients without CSIs. Independent risk factors for CSIs were male sex [hazard ratio (HR) = 6.4], a body mass index (BMI) < 20 kg/m(2) (versus a BMI > 25 kg/m(2), HR = 13.8), acute liver failure as an indication for LTx (HR = 7.1), a cold ischemic time > 420 minutes (HR = 3.5), and peak CRP (HR = 1.1) but not peak PCT. The addition of peak PCT marginally improved the c-statistic from 0.815 to 0.827. In conclusion, although peak PCT differed significantly between recipients with and without CSIs, it was not an independent risk factor for CSIs and added little prognostic accuracy. Interestingly, the parameters peak CRP, male sex, low BMI, acute liver failure, and long cold ischemic time were independent risk factors for CSIs. They could serve as risk stratifiers directing medical therapy in clinical practice.
临床显著感染（CSIs）是危及生命的，但在肝移植（LTx）后难以诊断。本研究探讨了降钙素原（PCT）除 C 反应蛋白（CRP）和白细胞计数（LC）之外作为 LTx 受者 CSI 预后标志物的价值。前瞻性研究了 135 名 LTx 受者的临床过程。CSIs 定义为肺部、血流或腹腔感染。通过 Cox 比例风险分析确定 CSI 的独立危险因素。使用一致性统计量（c 统计量）评估 PCT 的鉴别效果。30 名受者（22%）发生 CSI。与无 CSI 的受者相比，他们的 PCT 峰值（27.2 与 12.7ng/mL，P = 0.014）和 CRP 峰值（13.7 与 9.9mg/dL，P < 0.001）明显更高，LC 峰值（19.3 与 14.2cells/nL，P = 0.051）也有升高趋势。CSI 的独立危险因素为男性（HR = 6.4）、BMI < 20kg/m2（与 BMI > 25kg/m2 相比，HR = 13.8）、LTx 的适应症为急性肝衰竭（HR = 7.1）、冷缺血时间 > 420 分钟（HR = 3.5）和 CRP 峰值（HR = 1.1），但 PCT 峰值不是 CSI 的独立危险因素。PCT 峰值的加入略微提高了 c 统计量，从 0.815 提高到 0.827。总之，尽管 CSI 受者的 PCT 峰值差异有统计学意义，但它不是 CSI 的独立危险因素，对预后准确性的提高作用不大。有趣的是，CRP 峰值、男性、低 BMI、急性肝衰竭和长冷缺血时间是 CSI 的独立危险因素。它们可作为指导临床实践中药物治疗的风险分层指标。
