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Comparative Study
. 2024 Nov 25;24(1):428.
doi: 10.1186/s12876-024-03519-x.

Diagnostic performance of procalcitonin for bacterial infection in severe alcoholic hepatitis compared with C-reactive protein

Min Kyu Kang #  1 , Yu Rim Lee #  2 , Soo Young Park  3 , Kwang Il Seo  4 , Sang Soo Lee  5 , Byung Seok Kim  6 , Jeong Eun Song  6 , Jun Sik Yoon  7 , Young Mi Hong  8 , Ki Tae Yoon  8 , Woo Jin Chung  9 , Seung Ha Park  10 , Eunju Kim  10 , Kyung Ran Jun  11 , Jung Gil Park  1 , Yang-Hyun Baek #  12 , Nae-Yun Heo #  13
Affiliations
Comparative Study

Diagnostic performance of procalcitonin for bacterial infection in severe alcoholic hepatitis compared with C-reactive protein

Min Kyu Kang et al. BMC Gastroenterol. .

Abstract

Background: Severe alcoholic hepatitis is a catastrophic disease with a mortality rate of up to 35-50% at 30 days. Bacterial infection is an important prognostic factor in patients with severe alcoholic hepatitis, but it is difficult to detect the presence of infection immediately. Procalcitonin (PCT) is a well-known inflammatory marker that can detect bacterial infections in various diseases early. Therefore, we aimed to evaluate the diagnostic accuracy of PCT for bacterial infection in severe alcoholic hepatitis.

Methods: We prospectively enrolled patients with severe alcoholic hepatitis, defined as modified Maddrey's Discriminant Function ≥ 32, from 10 medical centers. At admission, we performed an initial evaluation including physical examination, laboratory test, radiology, blood and urine culture, PCT, and C-reactive protein (CRP). We compared the receiver operating characteristic (ROC) curves of PCT and CRP for bacterial infection, systemic inflammatory response syndrome (SIRS), and sepsis among total patients.

Results: A total of 108 patients with severe alcoholic hepatitis were enrolled. The number of bacterial infections, SIRS, and sepsis were 31 (28.7%), 41 (38.0%), and 19 (17.6%), respectively. The patients with bacterial infection had significantly higher MELD scores (24.0 vs. 15.0), PCT levels (1.5 vs. 0.4 ng/mL), and CRP levels (4.9 vs. 2.5 mg/dL) compared to those without bacterial infection. The area under the ROC curve (AUROC) of PCT vs. CRP for bacterial infection was 0.752 and 0.655, respectively (P = 0.113). The AUROC of PCT vs. CRP for SIRS was 0.699 and 0.662, respectively (P = 0.490). The AUROC of PCT vs. CRP for sepsis was 0.780 and 0.630, respectively (P = 0.027).

Conclusions: Among patients with severe alcoholic hepatitis, PCT showed a trend of superior diagnostic performance in the early detection of bacterial infection and sepsis compared to CRP. Although PCT might have better potential to diagnose sepsis in the setting of severe alcoholic hepatitis, it is necessary to find more reliable diagnostic markers.

Keywords: Alcoholic hepatitis; Bacterial infection; C-reactive protein; Procalcitonin; Sepsis.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study protocol was approved by Institutional review boards of all ten participating medical centers; Inje University Haeundae Paik Hospital (Inje University Haeundae Paik Hospital Institutional Review Board), Inje University Busan Paik Hospital (Inje University Busan Paik Hospital Institutional Review Board), Dong-A University Hospital (Dong-A University Hospital Institutional Review Board), Pusan National University Yangsan Hospital (Pusan National University Yangsan Hospital Institutional Review Board), Kosin University Gospel Hospital (Kosin University Gospel Hospital Institutional Review Board), Gyeongsang National University Changwon Hospital (Gyeongsang National University Changwon Hospital Institutional Review Board), Daegu Catholic University Medical Center (Daegu Catholic University Medical Center Institutional Review Board), Kyungpook National University Hospital/Kyungpook National University Chilgok Hospital (Kyungpook National University Hospital Institutional Review Board), Keimyung University Dongsan Hospital (Keimyung University Dongsan Hosptial Institutional Review Board), Yeungnam University Medical Center (Yeungnam University Hospital Institutional Review Board). Consent for publication: Not applicable. Informed consent: was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagnostic accuracy of procalcitonin and C-reactive protein for bacterial infection in severe alcoholic hepatitis
Fig. 2
Fig. 2
Diagnostic accuracy of procalcitonin and C-reactive protein for systemic inflammatory response syndrome in severe alcoholic hepatitis
Fig. 3
Fig. 3
Diagnostic accuracy of procalcitonin and C-reactive protein for sepsis in severe alcoholic hepatitis*
Fig. 4
Fig. 4
Diagnostic accuracy of procalcitonin and C-reactive protein for sepsis in severe alcoholic hepatitis accompanying systemic inflammatory response syndrome*
See this image and copyright information in PMC

References

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