title: Clinical significance of serum procalcitonin levels in patients with acute or chronic liver disease.
abstract: OBJECTIVE
  To evaluate the diagnostic value of serum procalcitonin levels in patients with acute or chronic liver disease, with or without bacterial infections and to correlate the results with the clinical outcome and the laboratory findings for these patients.
  
  
  METHODS
  One hundred and six consecutive hospitalized patients with liver disease were evaluated for procalcitonin levels on admission. Fifteen of them (14.2%) had acute alcoholic hepatitis on cirrhotic background (group A), 20 (18.9%) had alcoholic cirrhosis without hepatitis and/or bacterial infection (group B), 16 (15.1%) had decompensated cirrhosis with proved bacterial infection (group C), 42 (39.6%) had uncomplicated viral hepatitis-related cirrhosis (group D) and 13 (12.3%) had acute icteric viral hepatitis (group E). Serum procalcitonin levels were measured using an immunoluminometric assay. Statistical analysis was based on Student's t-test and the non-parametric Kruskall-Wallis test (P<0.05).
  
  
  RESULTS
  Serum procalcitonin levels were significantly higher in cirrhotic patients with bacterial infection (9.80+/-16.80 ng/ml) than in those without bacterial infection (0.21+/-0.13 ng/ml, P=0.001), whereas they were within normal range (<0.5 ng/ml) in all patients with uncomplicated cirrhosis, irrespective of the cause of cirrhosis. Seven of 15 group A patients (46.2%) and 4/13 group E patients (30.8%), all of them cirrhotics, had procalcitonin levels higher than 0.5 ng/ml on admission, without established bacterial infection.
  
  
  CONCLUSIONS
  Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.
authors.affiliation: Department of Internal Medicine, Hippokration Hospital of Athens, Carchidonos 9, A. Glyfada, GR-16562 Greece. ielefs@acn.gr
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Elefsiniotis
authors.forename: Michael
authors.initials: M
authors.lastname: Skounakis
authors.forename: Elena
authors.initials: E
authors.lastname: Vezali
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Pantazis
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Petrocheilou
authors.forename: Maria
authors.initials: M
authors.lastname: Pirounaki
authors.forename: George
authors.initials: G
authors.lastname: Papatsibas
authors.forename: Chrysa
authors.initials: C
authors.lastname: Kontou-Kastellanou
authors.forename: Antonios
authors.initials: A
authors.lastname: Moulakakis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001424:Bacterial Infections / Q000097:blood* / Q000150:complications; D001663:Bilirubin / Q000097:blood; D001772:Blood Cell Count; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006505:Hepatitis / Q000097:blood* / Q000150:complications; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000150:complications; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D011517:Prothrombin Time; D012709:Serum Albumin / Q000032:analysis; D014552:Urinary Tract Infections / Q000097:blood / Q000150:complications / Q000382:microbiology
chemical_list: C000606589:CALCA protein, human; D006454:Hemoglobins; D011498:Protein Precursors; D012709:Serum Albumin; D002116:Calcitonin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D015740:Calcitonin Gene-Related Peptide; D001663:Bilirubin