title: Kinetics of interleukin-6, procalcitonin, and C-reactive protein after pediatric liver transplantation.
abstract: In the early phase after pediatric liver transplantation (pLT) several concomitant factors may reduce the performance of established sepsis markers. To date, their clinical interpretation is hindered by a lack of information on their postoperative kinetics. To gather more information on the postoperative course and their changes in bacterial sepsis, we prospectively studied C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) on 9 perioperative days in 25 consecutive pLTs. After an initial postoperative peak, IL-6 and CRP levels significantly re-increased in patients with bacterial sepsis (P < .001). In contrast, PCT had very high postoperative levels; therefore severe infection was a comparatively inferior trigger for PCT elevation compared with the initial operation. The area under the receiver operating characteristic curve to diagnose postoperative sepsis for PCT was only 0.52, compared with 0.95 for IL-6 and 0.89 for CRP. None of the studied biomarkers were depressed by poor graft function. In conclusion, PCT performs poorly as a biomarker for sepsis in the early phase after pLT. With a rapid decline of initially elevated levels, IL-6 provides the best kinetics for detection of postoperative bacterial sepsis.
authors.affiliation: KUNO Children's University Hospital, Regensburg, Germany. Electronic address: robert.zant@ukr.de.
authors.forename: R
authors.initials: R
authors.lastname: Zant
authors.affiliation: KUNO Children's University Hospital, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Melter
authors.affiliation: KUNO Children's University Hospital, Regensburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Knoppke
authors.affiliation: KUNO Children's University Hospital, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ameres
authors.affiliation: KUNO Children's University Hospital, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kunkel
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000097:blood*; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000209:etiology
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