# Predictive Value of Procalcitonin and C-reactive Protein for Mortality in Live Donor Liver Transplant Recipients

## TL;DR

The study found that rising levels of procalcitonin and C-reactive protein after liver transplants predict higher mortality, even if they don't confirm infection.

## Contribution

The novel finding is that trends in PCT and CRP levels, not absolute values, are strong predictors of mortality in liver transplant recipients.

## Key findings

- Increasing CRP and PCT levels from postoperative days three to seven correlate with higher mortality rates in liver transplant patients.
- A decreasing trend in CRP and PCT is associated with significantly better survival rates at 30, 90, and 600 days post-transplant.
- Absolute values of CRP and PCT do not effectively diagnose infections in liver transplant recipients.

## Abstract

Background: Accurate biomarkers are crucial for the early diagnosis of sepsis after liver transplantation. This study aimed to evaluate the diagnostic accuracy of procalcitonin (PCT) and C-reactive protein (CRP) in predicting bacterial infections and mortality following living donor liver transplantation (LDLT).

Methodology: We prospectively analyzed all adult LDLT patients at a tertiary center between January 2021 and December 2022. CRP and PCT levels were measured on postoperative days (POD) one, three, five, and seven, and compared among patients without infections, those with bloodstream infections, and those with other infections (urinary, bronchoalveolar lavage, or drain). Multivariate logistic regression assessed the impact of PCT and CRP trends on short- and long-term mortality.

Results: Among 216 LDLT patients, 122 (56%) were analyzed after applying exclusion criteria. In patients without infections, median CRP and PCT levels were elevated on days one (CRP: 19, interquartile range (IQR): 11-29; PCT: 3, IQR: 1-13) and three (CRP: 18, IQR: 7-30; PCT: 2, IQR: 1-9) but decreased by days five (CRP: 10, IQR: 5-16; PCT: 1, IQR: 0.2-3) and seven (CRP: 10, IQR: 3-17; PCT: 0.7, IQR: 0.3-3). No absolute values of CRP or PCT effectively diagnosed infections. Patients with a decreasing trend in CRP from POD three to five to seven had survival rates of 90%, 86%, and 85% at 30, 90, and 600 days, respectively; in contrast, those with an increasing CRP trend had lower survival rates of 78%, 71%, and 40%, respectively. Similarly, a decline in PCT was associated with 30-, 90-, and 600-day survival rates of 90%, 85%, and 84%, while increasing PCT correlated with significantly lower rates of 75%, 70%, and 30%, respectively.

Conclusion: While the absolute values of CRP and PCT were not diagnostic for infection, an increase in these biomarkers from days three to five to seven predicted significantly higher short- and long-term mortality in LDLT recipients.