Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari, University of Venice, Italy.
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy.
Dig Liver Dis. 2024 May;56(5):810-817. doi: 10.1016/j.dld.2023.10.004. Epub 2023 Oct 14.
In patients with cirrhosis, infections significantly increase the risk of short and long-term mortality. During infection, the levels of procalcitonin increase, but it has not yet been clarified its prognostic value in subjects with cirrhosis. Therefore, the aim of this study was to evaluate the prognostic role of procalcitonin in patients with liver cirrhosis hospitalized for acute infection, and to compare it with other markers of infection.
We included 279 patients hospitalized because of infection, 133 with liver cirrhosis. At admission the levels of the main biochemical parameters of infection, i.e. leukocytes, procalcitonin, C reactive protein and lactate, were considered.
The duration of hospitalization and antibiotic therapy were longer in patients with cirrhosis, while no difference was observed for mortality. In both groups, a correlation with the duration of hospitalization and antibiotic therapy was observed for high levels of procalcitonin. In the cirrhotic population, in particular, higher procalcitonin values were associated with an increase in the length of hospitalization and antibiotic therapy, suggesting an even greater predictive value for those patients. High levels of leucocytes and lactate were positively associated with the duration of hospitalization, but not with the duration of antibiotic therapy. For mortality, the strongest correlation was found for high serum lactate levels, regardless of the presence of cirrhosis.
In patients with cirrhosis and acute infection, the value of procalcitonin at admission is a good prognostic indicator for the course of hospitalization, and could be useful for guiding the management and treatment of hospitalized patients.
在肝硬化患者中，感染显著增加了短期和长期死亡率的风险。在感染期间，降钙素原水平升高，但尚未明确其在肝硬化患者中的预后价值。因此，本研究旨在评估降钙素原在因急性感染住院的肝硬化患者中的预后作用，并将其与其他感染标志物进行比较。
我们纳入了 279 名因感染住院的患者，其中 133 名患有肝硬化。入院时考虑了感染的主要生化参数的水平，即白细胞、降钙素原、C 反应蛋白和乳酸。
肝硬化患者的住院时间和抗生素治疗时间较长，而死亡率无差异。在两组中，高水平的降钙素原与住院时间和抗生素治疗时间均呈正相关。特别是在肝硬化患者中，较高的降钙素原值与住院时间和抗生素治疗时间的延长相关，表明对这些患者具有更大的预测价值。白细胞和乳酸的高水平与住院时间呈正相关，但与抗生素治疗时间无关。对于死亡率，高血清乳酸水平的相关性最强，无论是否存在肝硬化。
在肝硬化合并急性感染的患者中，入院时降钙素原的水平是住院时间的良好预后指标，可能有助于指导住院患者的管理和治疗。
