Prognostic Value of Routine Biochemistry Profile of Liver Transplant Patients Admitted to the Emergency Department with a Suspected Infection

  • Ali Gur ORCID Mail Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey
  • Adem Kose ORCID Department of Infectious Diseases, School of Medicine, Inonu University, Malatya, Turkey
  • Hakan Oguzturk ORCID Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey
Keywords:
Emergency Department, Infections, Liver Function Tests, Liver Transplantation, Mortality

Abstract

Introduction: Since patients who have undergone liver transplantation should take immunosuppressants for life, the prevalence of systemic infections after this procedure is very high. These infections are associated with increased mortality and morbidity. Objective: This study aimed to investigate the prognostic value of routine biochemistry profile and its relationship with mortality in liver transplant patients admitted to the emergency department (ED) with a suspected infection. Methods: Patients who had undergone liver transplantation were included in the study. The patients were divided into three groups of culture-negative, culture-positive and control. White blood cell (WBC) count, hemoglobin (Hb), platelet (Plt), international normalized ratio (INR), creatinine (Cr), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values as well as vital sign findings were comparatively evaluated in terms of their ability to show the presence of any infection and their correlation with mortality. Results: Totally, 142 patients were enrolled and were divided into the following three groups: 41 cases in culture-negative group, 30 cases in culture-positive group, and 71 cases in control group. There was not any significant difference between study groups in terms of age and sex ratio (p>0.05). The Hb and Plt values ​​of the culture-positive patients were significantly lower, and their INR was significantly higher compared to those in control group (p<0.05). Fever, Hb, Plt, INR, AST and ALT values ​​were factors that had a significant correlation with mortality in patients with an infection whethere culture-positive or culture-negative ones (p<0.05). Conclusions: In patients admitted to the ED with a history of liver transplantation, we recommend the evaluation of vital signs and Hb, PLt, and INR values to determine whether there is an infection or not. We can also state that mortality risk is higher in cases with low Hb and Plt levels and high INR, ALT, and AST values.

Downloads

Download data is not yet available.

References

1. Moreno A, Cervera C, Gavalda J, Rovira M, De La Cámara R, Jarque I, et al. Bloodstream infections among transplant recipients: results of a Nationwide Surveillance in Spain 1. Am J Transplant. 2007;7(11):2579-86.
2. Chong AS, Alegre M-L. The impact of infection and tissue damage in solid-organ transplantation. Nat Rev Immunol. 2012;12(6):459-71.
3. Cooper D, Sharples L, Cornelissen J, Wallwork J, Alexander G, editors. Comparison between procalcitonin, serum amyloid A, and C-reactive protein as markers of serious bacterial and fungal infections after solid organ transplantation. Transplant Proc. 2001;33(1-2):1808-10.
4. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.
5. Hatipoglu H, Erkal S, Turkmen S, Engerek N, Kurt K, Siraneci R. Laboratory findings in the diagnosis of infectious diseases. JOPP Derg. 2011;3(1):5-11.
6. Gür A, Oguzturk H, Köse A, Turtay MG, Ersan V, BAYINDIR Y, et al. Prognostic value of procalcitonin, CRP, serum amyloid A, lactate and IL-6 markers in liver transplant patients admitted to ED with suspected infection. In Vivo. 2017;31(6):1179-85.
7. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret G-Y. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34(7):1996-2003.
8. Cetinkaya M, Özkan H, Köksal N, Celebi S, Hacımustafaoğlu M. Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants. J Perinatol. 2009;29(3):225-31.
9. van den Broek MA, Damink SWO, Winkens B, Broelsch CE, Malagó M, Paul A, et al. Procalcitonin as a prognostic marker for infectious complications in liver transplant recipients in an intensive care unit. Liver Transpl. 2010;16(3):402-10.
10. Pettilä V, Hynninen M, Takkunen O, Kuusela P, Valtonen M. Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med. 2002;28(9):1220-5.
11. Ghiani A, Sainis A, Sainis G, Neurohr C. Anemia and red blood cell transfusion practice in prolonged mechanically ventilated patients admitted to a specialized weaning center: an observational study. BMC Pulm Med. 2019;19(1):1-9.
12. Griffin BR, Bronsert M, Reece TB, Pal JD, Cleveland JC, Fullerton DA, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg. 2020;110(1):50-7.
13. Muhammed H, Gupta L, Lawrence A. Infections Are Leading Cause of In-Hospital Mortality in Indian Patients With Inflammatory Myopathy. J Clin Rheumatol. 2019; (ahead of print).
14. Santas E, Minana G, Gummel J, Farcasan R, Paya A, Heredia R, et al. International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists. Rev Esp Cardiol (Engl Ed). 2019;72(8):616-24.
15. Yaprak O, Guler N, Dayangac M, Demirbas BT, Yuzer Y, Tokat Y. Factors affecting perioperative mortality in right lobe liver transplantation with live donor. Turk J Surg. 2011;27(1):82-5.
16. Sasko B, Butz T, Prull MW, Liebeton J, Christ M, Trappe H-J. Earliest bedside assessment of hemodynamic parameters and cardiac biomarkers: their role as predictors of adverse outcome in patients with septic shock. Int J Med Sci. 2015;12(9):680-8.
17. Ersoy O. Evaluation of Liver Enzyme Height. Ankara Med J. 2012;12(3):129-35.
18. Yuwaki K, Shimazu T, Yamagiwa Y, Inoue M, Goto A, Yamaji T, et al. Association between serum liver enzymes and all‐cause mortality: The Japan Public Health Center‐based Prospective Study. Liver Int. 2019;39(8):1566-76.
19. Bueno-Cavanillas A, Delgado-Rodríguez M, López-Luque A, Schaffino-Cano S, Gálvez-Vargas R. Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med. 1994;22(1):55-60.
20. Ceylan E, Itil O, Ari G, Ellidokuz H, Ucan ES, Akkoclu A. Factors affecting mortality and morbidity in patients followed up in the internal medicine intensive care unit. Turk Thorac J. 2001;2(1):6-12.
Published
2020-09-21
How to Cite
1.
Gur A, Kose A, Oguzturk H. Prognostic Value of Routine Biochemistry Profile of Liver Transplant Patients Admitted to the Emergency Department with a Suspected Infection. Adv J Emerg Med.
Section
Original article