Association of postoperative day 1 procalcitonin levels with short-term mortality after liver transplantation: a single-center retrospective cohort study

BACKGROUND: Postoperative complications, especially infections, are important causes of poor prognosis after liver transplantation. Procalcitonin (PCT) has been proven to be a sensitive marker of infection and inflammation in many diseases. As a result, the purpose of this study was to determine the connection between early postoperative PCT levels and mortality in liver transplant patients. METHODS: We included 205 liver transplant recipients who underwent orthotopic allogeneic liver transplantation at Sun Yat-sen University's Sun Yat-sen Memorial Hospital. We grouped the patients according to the tertile of PCT levels on postoperative day one (POD 1) and divided the patients into three groups: Q1 (≤ 2.0 ng/ml), Q2 (2.1-5.0 ng/ml), and Q3 (≥ 5.1 ng/ml). To analyze the curvilinear association between PCT levels and 90-day mortality and in-hospital mortality, we used Spearman's rank correlation coefficient. The Kaplan-Meier method was used to assess survival rates at 30, 60 and 90 days after liver transplantation. The Log-rank test was used to analyze differences in survival rates between different PCT groups. RESULTS: Higher POD1 PCT levels were associated with increased 90-day and in-hospital mortality. Furthermore, this study revealed a statistically significant decrease in ICU-free days at 28-day, hospital-free days at 28-day, CRRT-free hours at 28-day, and hospital-free days at 60-day among patients in the group of high PCT level. CONCLUSIONS: Higher POD1 PCT levels were associated with worse short-term postoperative outcomes after liver transplantation. However, POD1 PCT should be interpreted as a potential early risk-associated biomarker rather than as an established independent prognostic factor.