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. 2025 Dec 30;17(12):e100440.
doi: 10.7759/cureus.100440. eCollection 2025 Dec.

Predictive Value of Procalcitonin and C-reactive Protein for Mortality in Live Donor Liver Transplant Recipients

Saraswathy S  1 , Johns Shaji Mathew  2 , Anila Kn  1 , Sreerenjini B  3 , Georg Gutjahr  4 , Shweta Mallick  1 , Binoj St  1 , Unnikrishnan G  1 , Dinesh Balakrishnan  1 , Sudhindran S  1
Affiliations

Predictive Value of Procalcitonin and C-reactive Protein for Mortality in Live Donor Liver Transplant Recipients

Saraswathy S et al. Cureus. .

Abstract

Background: Accurate biomarkers are crucial for the early diagnosis of sepsis after liver transplantation. This study aimed to evaluate the diagnostic accuracy of procalcitonin (PCT) and C-reactive protein (CRP) in predicting bacterial infections and mortality following living donor liver transplantation (LDLT).

Methodology: We prospectively analyzed all adult LDLT patients at a tertiary center between January 2021 and December 2022. CRP and PCT levels were measured on postoperative days (POD) one, three, five, and seven, and compared among patients without infections, those with bloodstream infections, and those with other infections (urinary, bronchoalveolar lavage, or drain). Multivariate logistic regression assessed the impact of PCT and CRP trends on short- and long-term mortality.

Results: Among 216 LDLT patients, 122 (56%) were analyzed after applying exclusion criteria. In patients without infections, median CRP and PCT levels were elevated on days one (CRP: 19, interquartile range (IQR): 11-29; PCT: 3, IQR: 1-13) and three (CRP: 18, IQR: 7-30; PCT: 2, IQR: 1-9) but decreased by days five (CRP: 10, IQR: 5-16; PCT: 1, IQR: 0.2-3) and seven (CRP: 10, IQR: 3-17; PCT: 0.7, IQR: 0.3-3). No absolute values of CRP or PCT effectively diagnosed infections. Patients with a decreasing trend in CRP from POD three to five to seven had survival rates of 90%, 86%, and 85% at 30, 90, and 600 days, respectively; in contrast, those with an increasing CRP trend had lower survival rates of 78%, 71%, and 40%, respectively. Similarly, a decline in PCT was associated with 30-, 90-, and 600-day survival rates of 90%, 85%, and 84%, while increasing PCT correlated with significantly lower rates of 75%, 70%, and 30%, respectively.

Conclusion: While the absolute values of CRP and PCT were not diagnostic for infection, an increase in these biomarkers from days three to five to seven predicted significantly higher short- and long-term mortality in LDLT recipients.

Keywords: c-reactive protein; live donor liver transplantation; post-operative; procalcitonin; sepsis.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of Amrita School of Medicine issued approval ECASM-AIMS-2025-284. Ethical concerns have not been observed in this study, and hence clearance is hereby granted. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Study profile.
HCC: hepatocellular carcinoma, DDLT: deceased donor liver transplants.
Figure 2
Figure 2. Thirty-day mortality: Kaplan-Meier survival curves comparing patients with no infection, bloodstream infection (BSI), and other infections.
30-day mortality was lowest in patients with no infections and highest in those with bloodstream infections (BSI).
Figure 3
Figure 3. CRP values in postoperative periods in patients with bloodstream infection, no infection, or other infections.
CRP values on postoperative days one, three, five, and seven in patients with bloodstream infection, no infection, or other infection were elevated across all three groups, with significant overlap between patients with and without infection. BSI: bloodstream infection; CRP: C-reactive protein.
Figure 4
Figure 4. PCT values on postoperative periods in patients with bloodstream infection, no infection, or other infections.
PCT values on postoperative days one, three, five, and seven were elevated across all groups, with significant overlap between patients with and without infection. PCT: procalcitonin; BSI: bloodstream infection.
Figure 5
Figure 5. ROC analysis for CRP and PCT on postoperative days three and five. (A) ROC analysis for CRP on day five; (B) ROC analysis for CRP on day seven; (C) ROC analysis for PCT on day five; and (D) ROC analysis for PCT on day seven.
ROC: receiver operating characteristic; CRP: C-reactive protein; PCT: procalcitonin; AUC: area under the curve.
Figure 6
Figure 6. Survival curves for different trends of PCT (A) and CRP (B).
PCT: procalcitonin; CRP: C-reactive protein.
See this image and copyright information in PMC

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