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Procalcitonin for infections in the first week after pediatric liver transplantation
Vladimir L Cousin1, Kalinka Lambert2, Shahar Trabelsi2
1Pediatric Gastroenterology Unit, University Hospitals Geneva, Rue Willy-Donzé 6, 1211, Geneva, Switzerland. vladimir.cousin@hcuge.ch.
Insights
Serial procalcitonin (PCT) measurements in the first week after pediatric liver transplantation (pLT) do not effectively detect bacterial infections. Elevated PCT levels post-pLT are not reliable indicators of infection during this early period.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Infectious Diseases
Background:
- Procalcitonin (PCT) is a widely recognized serum inflammatory marker.
- Pediatric liver transplantation (pLT) involves significant post-operative monitoring for complications.
- Early detection of bacterial infection is crucial for patient outcomes after pLT.
Purpose of the Study:
- To evaluate the kinetics of serial post-operative procalcitonin (PCT) measurements.
- To determine the usefulness of PCT in detecting bacterial infections in children following pLT.
- To assess the diagnostic performance of PCT during the first week post-transplant.
Main Methods:
- Retrospective chart review of pediatric liver transplant recipients.
- Serial serum PCT measurements were collected daily during the first post-operative week.
- Infection diagnosis was based on clinical and biological parameters; normal PCT defined as <0.5 ng/ml.
Main Results:
- Forty-one pLTs were analyzed in 39 patients; PCT levels initially rose then declined.
- Peak PCT reached a median of 5.61 ng/ml; 17 patients developed infections.
- No significant difference in daily or peak PCT was observed between infected and non-infected groups; ROC AUC was ≤0.6.
Conclusions:
- Serial PCT measurements within the first week post-pLT are not useful for identifying bacterial infections.
- The study suggests that PCT may become a useful marker for infection detection after the first post-operative week.
- Further research is warranted to explore the utility of PCT in later stages post-pLT.
Background:
Procalcitonin (PCT) has become a commonly used serum inflammatory marker. Our aim was to describe the kinetics and usefulness of serial post-operative PCT measurements to detect bacterial infection in a cohort of children immediately after pediatric liver transplantation (pLT).
Methods:
We performed a retrospective chart review of a cohort of pLT recipients with serial serum PCT measurements in the first week following pLT. The presence of infection was determined on clinical and biological parameters. Normal PCT was defined as < 0.5 (ng/ml).
Results:
Thirty-nine patients underwent 41 pLT. PCT was measured daily during the first week post pLT. Values first increased following surgery and then decreased, nearing 0.5 ng/ml at day seven. Peak PCT reached a median of 5.61 ng/ml (IQR 3.83-10.8). Seventeen patients were considered to have an infection. There was no significant difference in daily PCT or peak PCT between infected and non infected patients during the first post-operative week. AUC of ROC curve for PCT during first week was never higher than 0.6.
Conclusions:
We conclude that serial PCT measurements during the first week after pLT is not useful to identify patients with bacterial infections. Rather, we propose that serum PCT may be useful after the first week post pLT.
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