Role of Procalcitonin and C-Reactive Protein as Biomarkers of Infection in Children with Liver Disease.

Background and aim: Early and accurate identification of infection in patients with liver disease is challenging. This study evaluated the role of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers of bacterial infection in children with liver disease. Methods: Demographic and clinical data of consecutive children admitted with acute liver failure (ALF) or decompensated chronic liver disease (DCLD) were collected. PCT and CRP were measured within 24 hours of admission. Blood and urine culture, chest x-ray and ascitic fluid analysis was done. Results: 164 children (113 boys, age 76 (0.5-204) months, ALF -69, DCLD-95) were enrolled. 77 (47%) had infection. Most common site was ascitic fluid (n-35), followed by urinary tract (n-26), pneumonia (n-22) and blood stream infection (n- 16). 21 children had multiple site infections, 18 had severe sepsis and 36 had systemic inflammatory response syndrome (SIRS). PCT and CRP correlated with infection severity, highest in severe sepsis [(8.3 (3.5-38)ng/mL and 4.1 (0.3-13.8) mg/dL] than only infection [0.89 (0.1- 8) ng/mL and 1.7 (0.32-24) mg/dL] than no infection [0.3 (0.1-6.75) ng/mL and 0.3 (0.1-4.16 mg/dL). SIRS was commoner in patients with infection (31/77 vs. 5/87, p = 0.00). PCT (> 0.5 ng/ml) and CRP (>0.6 mg/dL) performed better in DCLD (AUC of 0.90 and 0.83) as compared to ALF patients (AUC of 0.73 and 0.69). Conclusion: : PCT and CRP are reliable markers of infection and correlate with infection severity in children with liver disease. Their diagnostic accuracy is better in DCLD than ALF cases. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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