Baseline evaluation of serum markers of inflammation and their utility in clinical practice in paediatric liver transplant recipients

Abstract

Background: Several biomarkers of penetrating infections vs. rejection in liver transplant (LT) have been suggested; however, baseline values in paediatric LT recipients have not been studied.

Aim: We evaluated the baseline concentration of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) in a post-LT paediatric group.

Methods: We measured serum PCT, CRP and IL-6 in 58 consecutive paediatric LT recipients. Specimens were collected for group 1 (n=22) at day 1, group 2 (n=12) at day 7 post-LT and group 3 (n=24) at onset of febrile episode. Day 7 samples were obtained from patients who had no graft dysfunction or signs/symptoms of sepsis.

Results: Median values for PCT were: group 1 was 5.16 μg/L (95% CI, 2.18-21.13); group 2: 0.170 μg/L (95% CI, 0.15-0.36) and, group 3: 1.93 μg/L (95% CI, 1.36-2.66) for bacterial and fungal infection, 0.19 μg/L (95% CI, 0.10-0.48) for rejection, and 0.31 μg/L (95% CI, 0.15-0.44) for viral infection. The area under the ROC (AUROC) for PCT, CRP and IL-6 in bacterial infection vs. rejection was 1.0 (P<0.0001), 0.842 (95% CI 0.686-0.998; P<0.0001) and 0.739 (95% CI 0.559-0.919; P 0.0046), respectively.

Conclusion: PCT levels were significantly higher in bacterial and fungal infection in comparison to other inflammatory markers. PCT proved to be the most specific parameter in differentiating bacterial infection from viral infection and allograft rejection.