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Kinetics of interleukin-6, procalcitonin, and C-reactive protein after pediatric liver transplantation
Insights
Interleukin-6 (IL-6) and C-reactive protein (CRP) effectively detect bacterial sepsis after pediatric liver transplantation (pLT). Procalcitonin (PCT) is unreliable due to high postoperative levels, making IL-6 the superior biomarker for early sepsis detection.
Area of Science:
- Pediatric transplantation
- Infectious disease diagnostics
- Critical care medicine
Background:
- Established sepsis markers may be less reliable in the early phase after pediatric liver transplantation (pLT).
- Limited data exists on the postoperative kinetics of these markers, hindering clinical interpretation.
- Understanding biomarker behavior is crucial for timely sepsis diagnosis in pLT patients.
Purpose of the Study:
- To prospectively investigate the postoperative kinetics of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) after pLT.
- To evaluate the diagnostic performance of these biomarkers for bacterial sepsis in the early postoperative period.
- To identify the most reliable biomarker for detecting bacterial sepsis following pLT.
Main Methods:
- Prospective study of 25 consecutive pLT recipients.
- Measurement of CRP, IL-6, and PCT levels over 9 perioperative days.
- Analysis of biomarker kinetics and diagnostic accuracy for bacterial sepsis using receiver operating characteristic curves.
Main Results:
- IL-6 and CRP levels showed significant increases in patients with bacterial sepsis after an initial postoperative peak.
- Procalcitonin (PCT) exhibited very high postoperative levels, diminishing its utility as a sepsis indicator compared to the initial operation.
- IL-6 (AUC 0.95) and CRP (AUC 0.89) demonstrated high diagnostic accuracy for sepsis, while PCT showed poor performance (AUC 0.52).
- Graft function did not appear to depress the studied biomarker levels.
Conclusions:
- Procalcitonin (PCT) is an unreliable biomarker for detecting early postoperative bacterial sepsis in pediatric liver transplant recipients.
- Interleukin-6 (IL-6), with its characteristic decline after initial elevation, offers the best kinetic profile for identifying bacterial sepsis post-pLT.
- CRP also shows promise, but IL-6's dynamic changes provide superior detection capabilities in this vulnerable patient population.
Abstract:
In the early phase after pediatric liver transplantation (pLT) several concomitant factors may reduce the performance of established sepsis markers. To date, their clinical interpretation is hindered by a lack of information on their postoperative kinetics. To gather more information on the postoperative course and their changes in bacterial sepsis, we prospectively studied C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) on 9 perioperative days in 25 consecutive pLTs. After an initial postoperative peak, IL-6 and CRP levels significantly re-increased in patients with bacterial sepsis (P < .001). In contrast, PCT had very high postoperative levels; therefore severe infection was a comparatively inferior trigger for PCT elevation compared with the initial operation. The area under the receiver operating characteristic curve to diagnose postoperative sepsis for PCT was only 0.52, compared with 0.95 for IL-6 and 0.89 for CRP. None of the studied biomarkers were depressed by poor graft function. In conclusion, PCT performs poorly as a biomarker for sepsis in the early phase after pLT. With a rapid decline of initially elevated levels, IL-6 provides the best kinetics for detection of postoperative bacterial sepsis.
