Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure

Area of Science:

• Hepatology
• Infectious Disease Diagnostics
• Critical Care Medicine

Background:

• Acute liver failure (ALF) presents clinical challenges in distinguishing bacterial infections from severe sepsis.
• Procalcitonin (PCT) is a recognized biomarker for bacterial infection detection.

Purpose of the Study:

• To evaluate the diagnostic accuracy of PCT in identifying bacterial infections in ALF patients.
• To determine if PCT levels can differentiate between infected and uninfected ALF cases.

Main Methods:

• Retrospective analysis of 115 ALF patients from the Acute Liver Failure Study Group.
• Inclusion of 20 uninfected chronic liver disease (CLD) patients as controls.
• Classification of ALF patients based on disease severity and etiology.

Main Results:

• Elevated PCT concentrations were observed in most ALF patients, often exceeding the 2.0 ng/mL sepsis threshold.
• No significant difference in PCT levels was found between ALF patients with and without documented infections (p = 0.169).
• PCT levels in ALF patients were significantly higher than in CLD controls (p ≤0.001), and acetaminophen toxicity cases showed elevated PCT irrespective of infection status.

Conclusions:

• PCT demonstrates poor discrimination for bacterial infection in ALF patients, likely due to severe inflammation and hepatocyte necrosis.
• Elevated PCT levels in ALF are not solely indicative of bacterial infection, rendering the biomarker unreliable in this context.