Bolia Rishi, Srivastava Anshu, Marak Rungmei, Yachha Surender K, Poddar Ujjal
*Departments of Pediatric Gastroenterology †Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Pediatr Gastroenterol Nutr. 2016 Oct;63(4):406-11. doi: 10.1097/MPG.0000000000001181.
Early and accurate identification of infection in patients with liver disease is challenging. The present study evaluated the role of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers of bacterial infection in children with liver disease.
Demographic and clinical data of consecutive children admitted with acute liver failure (ALF) or decompensated chronic liver disease (DCLD) were collected. PCT and CRP were measured within 24 hours of admission. Blood and urine culture, chest x-ray, and ascitic fluid analysis were done.
One hundred sixty-four children (113 boys, age 76 [0.5-204] months, ALF 69, DCLD 95) were enrolled. Seventy-seven (47%) had infection. Most common site was ascitic fluid (n = 35), followed by urinary tract (n = 26), pneumonia (n = 22), and blood stream infection (n = 16). Twenty-one children had multiple-site infections, 18 had severe sepsis, and 36 had systemic inflammatory response syndrome. PCT and CRP correlated with infection severity, higher in severe sepsis (8.3 [3.5-38] ng/mL and 4.1 [0.3-13.8] mg/dL) than only infection (0.89 [0.1-8] ng/mL and 1.7 [0.32-24] mg/dL) and no infection (0.3 [0.1-6.75] ng/mL and 0.3 [0.1-4.16 mg/dL]). Systemic inflammatory response syndrome was more common in patients with infection (31/77 vs 5/87, P = 0.00). PCT (>0.5 ng/mL) and CRP (>0.6 mg/dL) performed better in DCLD (AUC of 0.90 and 0.83) compared with patients with ALF (AUC of 0.73 and 0.69).
PCT and CRP are reliable markers of infection and correlate with infection severity in children with liver disease. Their diagnostic accuracy is better in DCLD than ALF cases.
早期准确识别肝病患者的感染具有挑战性。本研究评估降钙素原（PCT）和C反应蛋白（CRP）作为肝病患儿细菌感染生物标志物的作用。
收集连续收治的急性肝衰竭（ALF）或失代偿性慢性肝病（DCLD）患儿的人口统计学和临床数据。入院24小时内检测PCT和CRP。进行血培养、尿培养、胸部X光检查和腹水分析。
共纳入164例患儿（113例男孩，年龄76[0.5 - 204]个月，ALF 69例，DCLD 95例）。77例（47%）发生感染。最常见部位是腹水（n = 35），其次是泌尿道（n = 26）、肺炎（n = 22）和血流感染（n = 16）。21例患儿有多处感染，18例有严重脓毒症，36例有全身炎症反应综合征。PCT和CRP与感染严重程度相关，严重脓毒症时更高（8.3[3.5 - 38]ng/mL和4.1[0.3 - 13.8]mg/dL），高于单纯感染（0.89[0.1 - 8]ng/mL和1.7[0.32 - 24]mg/dL）和无感染（0.3[0.1 - 6.75]ng/mL和0.3[0.1 - 4.16]mg/dL）。全身炎症反应综合征在感染患者中更常见（31/77对5/87，P = 0.00）。与ALF患者（AUC分别为0.73和0.69）相比，PCT（>0.5 ng/mL）和CRP（>0.6 mg/dL）在DCLD患者中表现更好（AUC分别为0.90和0.83）。
PCT和CRP是肝病患儿感染的可靠标志物，且与感染严重程度相关。它们在DCLD中的诊断准确性优于ALF病例。
