Retrospective Study
Copyright ©The Author(s) 2016.
World J Gastroenterol. Nov 7, 2016; 22(41): 9172-9185
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9172
Table 1 Demographic, clinical and laboratory characteristics of patients with or without bacterial infections
Non-infectedInfectedP value
n14175
Gender (male/female)77/6441/34NS
Age (yr)57.3 ± 10.758.1 ± 9.7NS
Child-Pugh score6.9 ± 1.79.3 ± 2.2< 0.001
Child-Pugh stage, n (%)
A58 (41.1)6 (8.0)< 0.001
B65 (46.1)28 (37.3)
C18 (12.8)41 (54.7)
MELD score12.3 ± 4.119.1 ± 9.1< 0.001
Serum bilirubin (μmol/L)41.4 ± 38.3124.1 ± 147.4< 0.001
Serum albumin (g/L)35.4 ± 7.128.1 ± 6.5< 0.001
INR1.3 ± 0.21.6 ± 0.5< 0.001
Serum creatinine (μmol/L)83.8 ± 74.3131.2 ± 129.9< 0.001
Ascites present, n (%)58 (41.1)59 (78.7)< 0.001
HCC, n (%)4 (2.8)11 (14.7)0.003
Comorbidities present, n (%)72 (51.1)45 (60.0)NS
Type of bacterial infections, n (%)
UTI25 (29.4)
SBP20 (23.5)
Pneumonia18 (21.2)
SSTI4 (4.7)
Miscellaneous18 (21.2)
Multiple9 (10.6)
Acute phase proteins, median (IQR)
Presepsin (pg/mL)Overall477 (332-680)1002 (575-2149)< 0.001
OF absentOF present710 (533-1277)2357 (1398-3666)< 0.001
CRP (mg/L)Overall4.6 (1.8-8.8)30.1 (11.3-57.4)< 0.001
OF absentOF present25 (9.6-40.5)52.2 (23.4-84)0.027
PCT (μmol/L)Overall0.1 (0.1-0.2)0.4 (0.1-1.2)< 0.001
OF absentOF present0.2 (0.1-0.5)1.7 (0.6-5.3)< 0.001
Table 2 Association of classic acute phase proteins with mortality in patients with cirrhosis
Ref.YearJournalPopulationnOutcomeMeasureValue
C-reactive protein
Reuken et al[72]2013Liver IntAscites10890-d mortalityAUC0.69 (0.59-0.79), P = 0.001
Moreno et al[69]2013Liver IntNon-septic951-yr mortalityAUC0.71 (0.6-0.8), P < 0.001
Mortensen et al[70]2012Eur J Gastroenterol HepatolStable alcohol cirrhosis45Long term mortality (about 6- yr)HR1
1.074 (1.001-1.153), P = 0.046
Wiese et al[74]2014Liver IntStable cirrhotic1931- yr survivalHR1.18, P = 0.0483
Lim et al[68]2014Plos OneSBP7530-d mortalityAUC0.64 (0.49-0.79), P = 0.076
HRND, P = 0.064
Schwabl et al[73]2015Liver IntSBP16830-d mortalityHR11.067 (1.004-1.134), P = 0.037
Ha et al[65]2011Korean J Intern MedBacteraemia20230-d mortalityDifferenceSurvivor vs non-survivor2
37.8 vs 34.3 mg/L, P = 0.721
Cervoni et al[20]2012J HepatolCPs > 7148180-d mortalityAUC0.63 (0.51-0.73), P = ND
HR142.73 (1.41-5.26), P = 0.003
Di Martino et al[64]2015Liver TransplantCPs > 710990-d mortalityHR142.21 (1.03-4.76), P = 0.042
Cervoni et al[63]2016Eur J Gastroenterol HepatolCPs > 758390-d mortalityHR141.69 (1.01-2.81), P = 0.046
Park et al[71]2015J Korean Med SciAlcoholic cirrhosis various reasons for admission40930-d mortalityOR"CRP > 20 not independent predictor"
Ximenes et al[75]2016Am J Emerg MedHepatic decompensation149Inhospital mortalityOROR: ND, P > 0.100
Kwon et al[67]2015BMC GastroenterolAcute decompensation18430 d survivalOROR: ND, P = 0.122
Lazzarotto et al[19]2013Ann HepatolAcute decompensation6490 d survivalDifferenceSurvivor vs non-survivor2
7 vs 41 mg/L, P = 0.026
Kronenberger et al[66]2012BMC MedAcute decompensation + outpatients120Overall survival (196 ± 165 d)HRUnivariate: 0.314 (0.141-0.702) , P = 0.005
Multivariate: ND, P = 0.077
Procalcitonin
Lin et al[80]2015J Crit CareAcute decompensation96Sepsis in-hospital mortalityAUC0.692
Kotecha et al[79]2013Eur J Gastroenterol HepatolCirrhosis + SIRS100In-hospital survivalOR10.949 (0.868-1.037), P = 0.249
Connert et al[78]2003Z GastroenterolCompensated + decompensated10060-d mortalityPercent died< 0.58 vs≥ 0.58:
9.1% vs 46.7%, P < 0.001
Al-Dorzi et al[76]2014Clin LabSeptic shock4528-d mortalityDifferenceLow PCT vs high PCT:
80% vs 77%, P = 0.61
Berres et al[77]2009Liver IntCritically ill38ICU mortalityDifferenceNA, P = NS
Table 3 Correlations between presepsin and different laboratory parameters or liver-orientated scores
VariableSpearman’s rhoP value
CRP0.63< 0.001
PCT0.53< 0.001
Leucocyte count0.27< 0.001
Serum creatinine0.36< 0.001
Serum bilirubin0.28< 0.001
Serum albumin-0.40< 0.001
INR0.150.032
CPs0.42< 0.001
MELD score0.45< 0.001
Table 4 Performance characteristics of presepsin and other acute phase proteins during bacterial infections in patients with cirrhosis in various clinical settings
VariableCut-off valuesSensitivitySpecificityPPVNPVLR+LR-
INF overallPresepsin (pg/mL)84460.0%84.4567.2%79.9%3.850.47
PCT (μmol/L)0.3953.3%93.6581.6%79.0%8.360.50
CRP (mg/L)10.878.7%84.4%78.2%88.1%5.040.25
At least one marker positive (Presepsin/CRP)88.0%74.5%64.7%92.1%3.450.16
At least one marker positive (PCT/CRP)81.3%84.2%69.3%91.1%5.150.22
INF + OFPresepsin (pg/mL)120687.5%74.5%61.8%92.753.430.17
PCT (μmol/L)0.579.2%76.5%61.3%88.6%3.360.27
CRP (mg/L)40.562.5%76.5%55.6%81.2%2.660.49
Table 5 Performance characteristics of presepsin, procalcitonin and C-reactive protein for prediction of short-term (28-d) mortality in patients with bacterial infection (n = 75)
VariableCut-off valuesAUC-ROC (95%CI)SensitivitySpecificityPPVNPVLR+LR-
Presepsin (pg/mL)12770.76 (0.64-0.85)75.0%69.1%46.9%88.4%2.430.36
PCT (μmol/L)0.480.87 (0.77-0.93)90.0%74.6%56.2%95.3%3.540.13
CRP (mg/L)39.60.74 (0.63-0.84)75.0%74.6%51.7%89.1%2.950.34
Table 6 Association of presepsin, procalcitonin and C-reactive protein levels with short-term (28-d) mortality in patients with cirrhosis and bacterial infection
Binary logistic regression analysis
Univariate
Multivariate
UnadjustedP valueAdjusted for MELDP valueAdjusted for leucocyte countP valueAdjusted for MELD and leucocyte countP value
ln(Presepsin)3.59 (1.65-7.84)0.0011.9 (0.81-4.43)0.1382.91 (1.28-6.64)0.0111.61 (0.65-3.97)0.303
ln(PCT)2.54 (1.55-4.16)< 0.0011.89 (1.14-3.14)0.0142.33 (1.42-3.83)0.0011.81 (1.09-3.01)0.022
ln(CRP)2.17 (1.23-3.81)0.0071.73 (0.93-3.21)0.0811.84 (1.03-3.31)0.0401.56 (0.81-2.99)0.180