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Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation
Abstract Background Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Pro...
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| Published in: | Transplantation proceedings 2010-12, Vol.42 (10), p.4187-4190 |
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| description | Abstract Background Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumamatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT. Method We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group. Results The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT |
| doi_str_mv | 10.1016/j.transproceed.2010.08.070 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_820789788</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0041134510013722</els_id><sourcerecordid>820789788</sourcerecordid><originalsourceid>FETCH-LOGICAL-c530t-1715439028d3336861e5bd91e1e2e839384122f0a9370654e58bfcb5222614f33</originalsourceid><addsrcrecordid>eNqNkm-LEzEQxoMoXu_0K8giiK-2ziT7J-sLQaqnQsGDO98JIc3Oaup2U5P04L69s7aH4ishEJJ55snkNyPEc4QlAjavtssc7ZT2MTiifimBA6CX0MIDsUDdqlI2Uj0UC4AKS1RVfSbOU9oCn2WlHoszidjopoGF-HrFLnZ0PofJTwWv_J2Ka8rZT9-KMBSrsNuP3tlMfXEVUg57ijb7W-LIISYq7JApFmu-icXN77pGO2WWhOmJeDTYMdHT034hvly-v1l9LNefP3xavV2XrlaQS2yxrlQHUvdKKS4Mqd70HRKSJK06pSuUcgDbqRaauqJabwa3qaWUDVaDUhfi5dGXkfw8UMpm55OjkQuhcEhGS2h112rNytdHpYshpUiD2Ue_s_HOIJgZrtmav-GaGa4BbRguJz87PXPY7Dh2n3pPkwUvTgKbGOrARs6nP7r5I13bsu7dUUcM5dZTNMl5mhz1PpLLpg_-_-p584-NG_3EvRp_0B2lLfdnYuwGTZIGzPU8DvM0IACqVkr1C-zUs1g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>820789788</pqid></control><display><type>article</type><title>Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation</title><source>Elsevier:Jisc Collections:Elsevier Read and Publish Agreement 2022-2024:Freedom Collection (Reading list)</source><creator>Perrakis, A ; Yedibela, S ; Schellerer, V ; Hohenberger, W ; Müller, V</creator><creatorcontrib>Perrakis, A ; Yedibela, S ; Schellerer, V ; Hohenberger, W ; Müller, V</creatorcontrib><description>Abstract Background Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumamatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT. Method We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group. Results The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT <5 ng/mL and 10 above. The complication group included 14 patients who underwent 15 transplantations; Only 1 displayed a peakPCT <5 ng/mL. When the peak-PCT was >5 ng/mL, the odds ratio of a complication was 11.2 (95% Confidence interval, 10.81–11.59; P < .025). However, not before the 7th postoperative day was the course of mean PCT levels significantly different between the complication and noncomplication groups. In transplant patients, an elevation of PCT was observed only in the presence of bacterial infection and not rejection or wound infection. PCT rose during respiratory failure and sepsis, but not renal replacement therapy, ascites, pleural effusion, rejection, or bleeding. Conclusion PCT was a reliable marker. A decline was observed in 31 cases with subject, who both had fatal outcomes showing a constantly rising level. An initial high PCT indicated a poor prognosis; some members of the noncomplication group also had levels >15 ng/mL. The patients in the complication group showed a higher mean PCT, which was significant at 7 days, most probably because of the high variation among levels. Still, a peak-PCT >5 ng/mL showed an odds ratio of 11.2 for patients to experience a complication.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2010.08.070</identifier><identifier>PMID: 21168660</identifier><identifier>CODEN: TRPPA8</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Biomarkers - blood ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Liver Diseases - surgery ; Liver Transplantation ; Liver, biliary tract, pancreas, portal circulation, spleen ; Medical sciences ; Postoperative Period ; Prognosis ; Protein Precursors - blood ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Tissue, organ and graft immunology</subject><ispartof>Transplantation proceedings, 2010-12, Vol.42 (10), p.4187-4190</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c530t-1715439028d3336861e5bd91e1e2e839384122f0a9370654e58bfcb5222614f33</citedby><cites>FETCH-LOGICAL-c530t-1715439028d3336861e5bd91e1e2e839384122f0a9370654e58bfcb5222614f33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23841977$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21168660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perrakis, A</creatorcontrib><creatorcontrib>Yedibela, S</creatorcontrib><creatorcontrib>Schellerer, V</creatorcontrib><creatorcontrib>Hohenberger, W</creatorcontrib><creatorcontrib>Müller, V</creatorcontrib><title>Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation</title><title>Transplantation proceedings</title><addtitle>Transplant Proc</addtitle><description>Abstract Background Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumamatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT. Method We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group. Results The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT <5 ng/mL and 10 above. The complication group included 14 patients who underwent 15 transplantations; Only 1 displayed a peakPCT <5 ng/mL. When the peak-PCT was >5 ng/mL, the odds ratio of a complication was 11.2 (95% Confidence interval, 10.81–11.59; P < .025). However, not before the 7th postoperative day was the course of mean PCT levels significantly different between the complication and noncomplication groups. In transplant patients, an elevation of PCT was observed only in the presence of bacterial infection and not rejection or wound infection. PCT rose during respiratory failure and sepsis, but not renal replacement therapy, ascites, pleural effusion, rejection, or bleeding. Conclusion PCT was a reliable marker. A decline was observed in 31 cases with subject, who both had fatal outcomes showing a constantly rising level. An initial high PCT indicated a poor prognosis; some members of the noncomplication group also had levels >15 ng/mL. The patients in the complication group showed a higher mean PCT, which was significant at 7 days, most probably because of the high variation among levels. Still, a peak-PCT >5 ng/mL showed an odds ratio of 11.2 for patients to experience a complication.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Liver Diseases - surgery</subject><subject>Liver Transplantation</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Medical sciences</subject><subject>Postoperative Period</subject><subject>Prognosis</subject><subject>Protein Precursors - blood</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Tissue, organ and graft immunology</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqNkm-LEzEQxoMoXu_0K8giiK-2ziT7J-sLQaqnQsGDO98JIc3Oaup2U5P04L69s7aH4ishEJJ55snkNyPEc4QlAjavtssc7ZT2MTiifimBA6CX0MIDsUDdqlI2Uj0UC4AKS1RVfSbOU9oCn2WlHoszidjopoGF-HrFLnZ0PofJTwWv_J2Ka8rZT9-KMBSrsNuP3tlMfXEVUg57ijb7W-LIISYq7JApFmu-icXN77pGO2WWhOmJeDTYMdHT034hvly-v1l9LNefP3xavV2XrlaQS2yxrlQHUvdKKS4Mqd70HRKSJK06pSuUcgDbqRaauqJabwa3qaWUDVaDUhfi5dGXkfw8UMpm55OjkQuhcEhGS2h112rNytdHpYshpUiD2Ue_s_HOIJgZrtmav-GaGa4BbRguJz87PXPY7Dh2n3pPkwUvTgKbGOrARs6nP7r5I13bsu7dUUcM5dZTNMl5mhz1PpLLpg_-_-p584-NG_3EvRp_0B2lLfdnYuwGTZIGzPU8DvM0IACqVkr1C-zUs1g</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>Perrakis, A</creator><creator>Yedibela, S</creator><creator>Schellerer, V</creator><creator>Hohenberger, W</creator><creator>Müller, V</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101201</creationdate><title>Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation</title><author>Perrakis, A ; Yedibela, S ; Schellerer, V ; Hohenberger, W ; Müller, V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c530t-1715439028d3336861e5bd91e1e2e839384122f0a9370654e58bfcb5222614f33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Calcitonin - blood</topic><topic>Calcitonin Gene-Related Peptide</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Liver Diseases - surgery</topic><topic>Liver Transplantation</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Medical sciences</topic><topic>Postoperative Period</topic><topic>Prognosis</topic><topic>Protein Precursors - blood</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Tissue, organ and graft immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perrakis, A</creatorcontrib><creatorcontrib>Yedibela, S</creatorcontrib><creatorcontrib>Schellerer, V</creatorcontrib><creatorcontrib>Hohenberger, W</creatorcontrib><creatorcontrib>Müller, V</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perrakis, A</au><au>Yedibela, S</au><au>Schellerer, V</au><au>Hohenberger, W</au><au>Müller, V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation</atitle><jtitle>Transplantation proceedings</jtitle><addtitle>Transplant Proc</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>42</volume><issue>10</issue><spage>4187</spage><epage>4190</epage><pages>4187-4190</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><coden>TRPPA8</coden><abstract>Abstract Background Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumamatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT. Method We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group. Results The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT <5 ng/mL and 10 above. The complication group included 14 patients who underwent 15 transplantations; Only 1 displayed a peakPCT <5 ng/mL. When the peak-PCT was >5 ng/mL, the odds ratio of a complication was 11.2 (95% Confidence interval, 10.81–11.59; P < .025). However, not before the 7th postoperative day was the course of mean PCT levels significantly different between the complication and noncomplication groups. In transplant patients, an elevation of PCT was observed only in the presence of bacterial infection and not rejection or wound infection. PCT rose during respiratory failure and sepsis, but not renal replacement therapy, ascites, pleural effusion, rejection, or bleeding. Conclusion PCT was a reliable marker. A decline was observed in 31 cases with subject, who both had fatal outcomes showing a constantly rising level. An initial high PCT indicated a poor prognosis; some members of the noncomplication group also had levels >15 ng/mL. The patients in the complication group showed a higher mean PCT, which was significant at 7 days, most probably because of the high variation among levels. Still, a peak-PCT >5 ng/mL showed an odds ratio of 11.2 for patients to experience a complication.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>21168660</pmid><doi>10.1016/j.transproceed.2010.08.070</doi><tpages>4</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences Biomarkers - blood Calcitonin - blood Calcitonin Gene-Related Peptide Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Liver Diseases - surgery Liver Transplantation Liver, biliary tract, pancreas, portal circulation, spleen Medical sciences Postoperative Period Prognosis Protein Precursors - blood Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Tissue, organ and graft immunology |
| title | Procalcitonin in the Setting of Complicated Postoperative Course after Liver Transplantation |
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