QJM. 2026 Aug 1;119(Supplement_1):hcag168.106. doi: 10.1093/qjmed/hcag168.106.
ABSTRACT
BACKGROUND: Bacterial infections significantly worsen the prognosis of children with chronic liver disease, yet traditional inflammatory markers such as C-reactive protein (CRP) and total leukocyte count (TLC) often lack the specificity needed to reliably distinguish bacterial sepsis from non-infectious inflammation. Procalcitonin (PCT) has emerged as a promising biomarker because its synthesis is selectively upregulated in bacterial infections, providing an early and reliable indicator in this vulnerable population.
AIMS: This study aims to evaluate the diagnostic accuracy of serum procalcitonin in differentiating bacterial infections from non-infectious inflammatory states among pediatric patients with chronic liver disease. Also, it aims to compare the performance of procalcitonin with conventional parameters to establish a reliable cutoff for clinical decision making.
METHODS: A prospective case-control study was conducted involving 44 children with chronic liver disease subdivided into two groups-22 patients with clinical and laboratory evidence of bacterial infection and 22 without-were recruited from hepatology clinic, Children’s Hospital, Ain Shams University and 23 age- and sex-matched healthy controls. All participants underwent detailed clinical assessments including vital signs, comprehensive liver function tests, and inflammatory marker measurements. Serum procalcitonin levels were determined using an enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal procalcitonin cutoff, with its sensitivity, specificity, and predictive values assessed.
RESULTS: Procalcitonin levels were found to be significantly higher in the bacterial infection group (median: 0.95 ng/mL; interquartile range [IQR]: 0.70-1.90) compared to both the non-infected chronic liver disease group (median: 0.04 ng/mL; IQR: 0.02-0.06) and the control group (median: 0.05 ng/mL; IQR: 0.02-0.07) (p < 0.001). At a cutoff value of 0.07 ng/mL, procalcitonin achieved a sensitivity of 95.5% and a specificity of 77.3% (area under the curve [AUC]: 0.901, 95% confidence interval: 0.773-0.970, p < 0.001) for detecting bacterial infection in these patients. Moreover, statistically significant positive correlations were observed between procalcitonin levels and both CRP and INR as a marker of liver dysfunction, while an inverse correlation was noted with platelet count.
CONCLUSION: Serum procalcitonin is a highly sensitive and specific biomarker for detection of bacterial infections in children and adolescents with chronic liver disease with a lower cut off value compared to normal population. Despite specificity to bacterial infection, still its value is comparable to conventional inflammatory markers. Future larger studies are warranted to validate these findings and optimize clinical protocols.
PMID:42689343 | DOI:10.1093/qjmed/hcag168.106
