title: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Paediatric Liver, GI & Nutrition Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. tassos.grammat@nhs.net
authors.forename: Tassos
authors.initials: T
authors.lastname: Grammatikopoulos
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bansal
authors.forename: Jim
authors.initials: J
authors.lastname: Wade
authors.forename: Roy
authors.initials: R
authors.lastname: Sherwood
authors.forename: Tracy
authors.initials: T
authors.lastname: Dew
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.forename: Anita
authors.initials: A
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000097:blood*; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide