title: Ultra-sensitive procalcitonin may help rule out bacterial infections in patients with cirrhosis.
abstract: BACKGROUND
  Bacterial infections are frequent complications in patients with cirrhosis. Since they are associated with poor outcomes, antibiotics are frequently over-prescribed. Surrogate markers of bacterial infections, like procalcitonin, are needed to better discriminate between infected and not infected patients.
  
  
  OBJECTIVE
  To evaluated the diagnostic accuracy of an ultra-sensitive procalcitonin assay for the diagnosis of bacterial infections in patients with cirrhosis.
  
  
  METHODS
  In a single-center prospective study, we determined the basal levels of procalcitonin in 106 episodes of admissions to the emergency department in 84 cirrhotic patients. Patients were classified as infected or not infected by two independent hepatologists blinded to the procalcitonin result.
  
  
  RESULTS
  The prevalence of bacterial infection was 28% (29 episodes). The median procalcitonin was significantly higher in the infected group than in the not infected group (0.45 vs. 0.061 ng/mL, p < 0.001). The diagnostic accuracy of procalcitonin for bacterial infection estimated by the ROC curve was 0.95 (CI: 95%, 0.91-0.99). When selecting a cutoff value of 0.098 ng/mL a sensitivity of 97% and a negative predictive value 98% were found.
  
  
  CONCLUSIONS
  The use of an ultra-sensitive procalcitonin assay identifies patients with cirrhosis at very low risk of bacterial infections.
authors.affiliation: Liver Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Marciano
authors.affiliation: Liver Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Leila
authors.initials: L
authors.lastname: Haddad
authors.affiliation: Clinical Analysis Department, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Alfredo Pedro
authors.initials: AP
authors.lastname: Martínez
authors.affiliation: Internal Medicine Research Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: María L
authors.initials: ML
authors.lastname: Posadas
authors.affiliation: Liver Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.affiliation: Liver Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Mora
authors.affiliation: Clinical Analysis Department, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Guerrero
authors.affiliation: Liver Unit, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Ridruejo
authors.affiliation: Liver Unit, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Oscar G
authors.initials: OG
authors.lastname: Mandó
authors.affiliation: Internal Medicine Research Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Diego H
authors.initials: DH
authors.lastname: Giunta
authors.affiliation: Liver Unit, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Adrián C
authors.initials: AC
authors.lastname: Gadano
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019540:Area Under Curve; D001118:Argentina / Q000453:epidemiology; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D015854:Up-Regulation
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide