Difference in serum procalcitonin levels between decompensated liver cirrhosis patients with and without bacterial infection

Background: Decompensated liver cirrhosis may increase procalcitonin (PCT) levels in patients without bacterial infection. Previous studies have not provided conclusive results about the difference in serum PCT levels caused by specific liver decompensation and bacterial infection. Objective: To examine the role of PCT in assisting the diagnosis of bacterial infection in decompensated liver cirrhosis patients. Methods: A cross-sectional study on decompensated liver cirrhosis patients who were outpatients and admitted to Cipto Mangunkusumo Hospital, Jakarta, was conducted between December 2015 until May 2016. Procalcitonin levels were examined and bacterial infection was identified using standard criteria for each type of infection suspected. Analysis was performed to determine the difference in PCT levels between patients with and without bacterial infection, and to obtain the cutoff point of PCT for bacterial infection diagnosis using the receiver operating characteristic (ROC) curve. Results: There were 38 patients with decompensated liver cirrhosis, 16 (42.1%) with bacterial infection, and 22 (57.9%) without bacterial infection. Patients with bacterial infection (3.607±0.643 ng/ml) had significantly higher PCT levels than those without bacterial infection (0.738±1.185 ng/ml). The level of PCT for bacterial infection in decompensated liver cirrhosis had an area under the ROC curve of 0.933 (CI 0.853-1.014). The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml, with a sensitivity of 87.5% and specificity of 86.4%. Conclusion: The PCT levels of decompensated liver cirrhosis patients with bacterial infection were higher than those of patients without bacterial infection. The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml.