RESEARCH ARTICLE
Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure Jody A. Rule1,3☯*, Linda S. Hynan2☯, Nahid Attar1‡, Corron Sanders1‡, William J. Korzun3☯, William M. Lee1☯, Acute Liver Failure Study Group¶ 1 Department of Internal Medicine, Division of Digestive Diseases, UT Southwestern Medical Center, Dallas, Texas, United States of America, 2 Department of Clinical Sciences and Department of Psychiatry, Division of Biostatistics, UT Southwestern Medical Center, Dallas, Texas, United States of America, 3 Department of Clinical Laboratory Sciences, School of Allied Health, Virginia Commonwealth University, Richmond, Virginia, United States of America ☯ These authors contributed equally to this work. ‡ These authors also contributed equally to this work. ¶ Membership of the Acute Liver Failure Study Group is listed in the Acknowledgments. * [email protected]
Abstract OPEN ACCESS Citation: Rule JA, Hynan LS, Attar N, Sanders C, Korzun WJ, Lee WM, et al. (2015) Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure. PLoS ONE 10(9): e0138566. doi:10.1371/journal.pone.0138566 Editor: Helge Bruns, University Hospital Oldenburg, GERMANY
Background Because acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF.
Received: April 14, 2015 Accepted: September 1, 2015
Method
Published: September 22, 2015
Retrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls.
Copyright: © 2015 Rule et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are contained within the supporting information file. Funding: This work was supported by the National Institutes of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, W. M. Lee, Principal Investigator [grant U-01 DK58369]. Additional support was provided by Siemens Healthcare Diagnostics, Tarrytown, NY. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Results Procalcitonin concentrations in most samples were elevated, with median values for all ALF groups near or above a 2.0 ng/mL cut-off that generally indicates severe sepsis. While PCT concentrations increased somewhat with apparent liver injury severity, there were no differences in PCT levels between the pre-defined severity groups–non-SIRS and SIRS groups with no documented infections and Severe Sepsis and Septic Shock groups with documented infections, (p = 0.169). PCT values from CLD patients differed from all ALF groups (median CLD PCT value 0.104 ng/mL, (p 0.001)). Subjects with acetaminophen (APAP) toxicity, many without evidence of infection, demonstrated median PCT >2.0 ng/mL, regardless of SIRS features, while some culture positive subjects had PCT values
Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure Jody A. Rule1,3☯*, Linda S. Hynan2☯, Nahid Attar1‡, Corron Sanders1‡, William J. Korzun3☯, William M. Lee1☯, Acute Liver Failure Study Group¶ 1 Department of Internal Medicine, Division of Digestive Diseases, UT Southwestern Medical Center, Dallas, Texas, United States of America, 2 Department of Clinical Sciences and Department of Psychiatry, Division of Biostatistics, UT Southwestern Medical Center, Dallas, Texas, United States of America, 3 Department of Clinical Laboratory Sciences, School of Allied Health, Virginia Commonwealth University, Richmond, Virginia, United States of America ☯ These authors contributed equally to this work. ‡ These authors also contributed equally to this work. ¶ Membership of the Acute Liver Failure Study Group is listed in the Acknowledgments. * [email protected]
Abstract OPEN ACCESS Citation: Rule JA, Hynan LS, Attar N, Sanders C, Korzun WJ, Lee WM, et al. (2015) Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure. PLoS ONE 10(9): e0138566. doi:10.1371/journal.pone.0138566 Editor: Helge Bruns, University Hospital Oldenburg, GERMANY
Background Because acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF.
Received: April 14, 2015 Accepted: September 1, 2015
Method
Published: September 22, 2015
Retrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls.
Copyright: © 2015 Rule et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are contained within the supporting information file. Funding: This work was supported by the National Institutes of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, W. M. Lee, Principal Investigator [grant U-01 DK58369]. Additional support was provided by Siemens Healthcare Diagnostics, Tarrytown, NY. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Results Procalcitonin concentrations in most samples were elevated, with median values for all ALF groups near or above a 2.0 ng/mL cut-off that generally indicates severe sepsis. While PCT concentrations increased somewhat with apparent liver injury severity, there were no differences in PCT levels between the pre-defined severity groups–non-SIRS and SIRS groups with no documented infections and Severe Sepsis and Septic Shock groups with documented infections, (p = 0.169). PCT values from CLD patients differed from all ALF groups (median CLD PCT value 0.104 ng/mL, (p 0.001)). Subjects with acetaminophen (APAP) toxicity, many without evidence of infection, demonstrated median PCT >2.0 ng/mL, regardless of SIRS features, while some culture positive subjects had PCT values
