Serial Procalcitonin Measurements for Determining Bacterial Infection and Mortality in Cirrhotic Patients with Systemic Inflammatory Response Syndrome

Abstract

INTRODUCTION: The utility of serial procalcitonin (PCT) measurements in cirrhotic patients with systemic inflammatory response syndrome (SIRS) is not well understood. This study aimed to assess the effectiveness of serial PCT measurements for diagnosing bacterial infections and predicting 30-day mortality in this population. METHODS: We prospectively studied 120 cirrhotic patients with SIRS, 64.2% of whom had bacterial infections. Serial PCT levels were measured within the first 72 hours of admission. RESULTS: Patients with bacterial infections had significantly higher PCT levels at admission, 24 hours, and 72 hours compared to those without infections. PCT values >0.5 ng/mL within 72 hours demonstrated high sensitivity (81.8-87.5%) but moderate specificity (27.9-44.2%) for diagnosing bacterial infections. Serial PCT monitoring, including the 72-hour/baseline ratio and changes in PCT over 72 hours, provided insights into the evolution of bacterial infections and short-term mortality. Patients with a PCT 72-hour/baseline ratio >0.8 had higher 30-day mortality than those with a ratio <0.5 (50.0% vs. 25.6%; OR 3.91, 95% CI 1.40-10.97). Patients whose PCT levels decreased by >50% had lower 30-day mortality than those with increasing levels (23.3% vs. 46.7%; OR 0.25, 95% CI 0.08-0.74). Patients with MELD scores >15 and bacterial infections who experienced a PCT decrease of <50% had higher 30-day mortality than those with greater reductions (57.7% vs. 25.0%, p=0.021). DISCUSSION: Serial PCT measurements within 72 hours of admission are useful for determining bacterial infections and mortality in cirrhotic patients with SIRS. PCT monitoring may optimize antibiotic use and enhance early risk stratification, potentially improving patient outcomes.