The Role of Presepsin and Procalcitonin in Early Diagnosis of Bacterial Infections in Cirrhotic Patients with Acute-on-Chronic Liver Failure

Razvan Igna, Irina Gîrleanu, Camelia Cojocariu, Laura Huiban, Cristina Muzîca, Ana-Maria Sîngeap, Cătălin Sfarti, Stefan Chiriac, Oana Cristina Petrea, Sebastian Zenovia, Robert Nastasa, Tudor Cuciureanu, Remus Stafie, Ermina Stratina, Adrian Rotaru, Carol Stanciu, Mihaela Blaj, Anca Trifan, Razvan Igna, Irina Gîrleanu, Camelia Cojocariu, Laura Huiban, Cristina Muzîca, Ana-Maria Sîngeap, Cătălin Sfarti, Stefan Chiriac, Oana Cristina Petrea, Sebastian Zenovia, Robert Nastasa, Tudor Cuciureanu, Remus Stafie, Ermina Stratina, Adrian Rotaru, Carol Stanciu, Mihaela Blaj, Anca Trifan

Abstract

Background and Objectives: Bacterial infections represent one of the most frequent precipitating events of acute-on-chronic liver failure (ACLF) in a patient with liver cirrhosis (LC). Early diagnosis and treatment could influence the ACLF reversal rate and decrease the mortality rate in these patients. The study aimed to evaluate the role of presepsin, C-reactive protein (CRP), and procalcitonin (PCT) in the early diagnosis of bacterial infections in patients with LC and ACLF, defined according to the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria. Material and Methods: We performed a prospective observational study including all consecutive cirrhotic patients with ACLF admitted to our tertiary university center. The patients were follow-up until discharge. All patients were screened for infection at admission, and we included patients with community-acquired or healthcare-associated bacterial infections. Results: In this study, we included 153 patients with a median age of 60 years, of whom 65.4% were male. Infections were diagnosed in 71 patients (46.4%). The presepsin, CRP, and PCT levels were higher in patients with infections than in those without infections (p < 0.001, p = 0.023, and p < 0.001, respectively). The ROC analysis results demonstrated that the best cut-offs values for infections diagnosis were for presepsin 2300 pg/mL (sensitivity of 81.7%, specificity of 92.7%, AUROC 0.959, p < 0.001), CRP 5.3 mg/dL (sensitivity of 54.9%, specificity of 69.6%, AUROC 0.648, p = 0.023), and PCT 0.9 ng/mL (sensitivity of 80.3%, specificity of 86.6%, AUROC 0.909, p < 0.001). Presepsin (OR 3.65, 95%CI 1.394−9.588, p = 0.008), PCT (OR 9.79, 95%CI 6.168−25.736, p < 0.001), and MELD score (OR 7.37, 95%CI 1.416−18.430, p = 0.018) were associated with bacterial infections in patients with ACLF. Conclusion: Presepsin level ≥2300 pg/mL and PCT level ≥0.9 ng/mL may be adequate non-invasive tools for the early diagnosis of infections in cirrhotics with ACLF.

Keywords: acute-on-chronic liver failure; bacterial infections; biomarkers; presepsin; procalcitonin.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
STROBE flow diagram of patients included and excluded from the study.
Figure 2
Figure 2
Presepsin (a), CRP (b), and procalcitonin (c) levels among patients with ACLF, with or without infections.
Figure 2
Figure 2
Presepsin (a), CRP (b), and procalcitonin (c) levels among patients with ACLF, with or without infections.
Figure 3
Figure 3
Comparisons of the three biomarkers’ ROC curves.
Figure 4
Figure 4
ROC curve for procalcitonin and in-hospital mortality (blue line—ROC curve, green line—reference line).

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