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Vol. 44. Issue 5.
Pages 275-282 (June - July 2020)
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Vol. 44. Issue 5.
Pages 275-282 (June - July 2020)
Original
DOI: 10.1016/j.medine.2019.02.013
C-reactive protein at ICU admission as a marker of early graft dysfunction after liver transplant. A prospective, single-center cohort study
Proteína C reactiva al ingreso en UCI como marcador de disfunción temprana del injerto tras trasplante hepático. Estudio unicéntrico, prospectivo y de cohortes
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G. Seller-Péreza, J.E. Barrueco-Francionia,c, R. Lozano-Sáeza, M.M. Arrebola-Ramírezb, M.J. Diez-de-los-Ríosb, G. Quesada-Garcíaa, M.E. Herrera-Gutiérreza,c,
Corresponding author
mehguci@gmail.com

Corresponding author.
a Intensive Care Medicine Unit, Regional University Hospital of Malaga, Spain
b Clinical Analysis Department, Regional University Hospital of Malaga, Spain
c Faculty of Medicine, Universidad de Málaga, Spain
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Tables (3)
Table 1. Daily changes in C-reactive protein and other variables used to monitor liver function after liver transplant.
Table 2. Changes in liver function markers in relation to severe EAD.
Table 3. Changes in liver function markers in relation to in-hospital mortality.
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Additional material (1)
Abstract
Objective

To explore the behavior of C-reactive protein (CRP) after orthotopic liver transplantation (OLT) during the first postoperative days, and its usefulness as a marker of severe early allograft dysfunction (EAD).

Design

A prospective, single-center cohort study was carried out.

Setting

The Intensive Care Unit (ICU) of a regional hospital with a liver transplant program since 1997.

Patients

The study comprised a total of 183 patients admitted to our ICU immediately after liver transplantation between 2009 and 2015.

Variables of interest

C-reactive protein levels upon ICU admission and after 24 and 48h, severe EAD and hospital mortality.

Results

The CRP levels after OLT were: upon ICU admission 57.5 (51.6–63.3)mg/L, after 24h 80.1 (72.9–87.3)mg/L and after 48h 69.9 (62.5–77.4)mg/L. Severe EAD patients (14.2%) had higher mortality (23.1 vs 2.5; OR 11.48: 2.98–44.19) and lower CRP upon ICU admission (39.3 [29.8–48.7]mg/L) than the patients without EAD (0.5 [53.9–67.0]; p<0.05] – the best cut-off point being 68mg/L (sensitivity 92.3%; specificity 40.1%; Youden index 0.33).

Lower CRP upon ICU admission was correlated to higher mortality (24.5 [9.2–39.7] vs 59.4 [53.4–65.4]; p<0.01, AUC 0.79 [0.65–0.92]).

Conclusion

Liver transplant is a strong inflammatory stimulus accompanied by high levels of C-reactive protein. A blunted rise in CRP on the first postoperative day after OLT may be a marker of poor allograft function and is related to hospital mortality.

Keywords:
C-reactive protein
Biomarker
Early allograft dysfunction
Primary graft dysfunction
Outcome
Postoperative complication
Liver function test
Abbreviations:
ALT
APACHE II
AST
AuC
CRP
EAD
ICU
INR
MEAF
MELD
OLT
OR
ROC
Resumen
Objetivo

Explorar el comportamiento de la proteína C reactiva (PCR) en el postoperatorio inmediato de trasplante hepático y su utilidad como marcador de disfunción grave del injerto hepático.

Diseño

Estudio de cohortes prospectivo, unicéntrico.

Ámbito

Unidad de cuidados intensivos (UCI) de un hospital regional.

Pacientes

Ciento ochenta y tres pacientes ingresados en nuestra UCI inmediatamente después del trasplante hepático entre 2009-2015.

Variables de interés

Niveles de PCR al ingreso en UCI, 24 y 48h, disfunción grave del injerto hepático, mortalidad intrahospitalaria.

Resultados

Los niveles de PCR en el postoperatorio inmediato de trasplante fueron: al ingreso en UCI 57,5 (51,6-63,3)mg/L, a las 24h 80,1 (72,9-87,3)mg/L y a las 48h 69,9 (62,5-77,4)mg/L. Los pacientes con disfunción grave del injerto (14,2%) tuvieron una mayor mortalidad (23,1 vs. 2,5; OR 11,48: 2,98-44,19) y PCR más baja al ingreso en UCI (39,3 [29,8-48,7]mg/L) que los pacientes sin disfunción grave (0,5 [53,9-67]; p<0,05), siendo el mejor punto de corte para la PCR de 68mg/L (sensibilidad 92,3%; especificidad 40,1%; índice de Youden 0,33).

La PCR baja al ingreso tuvo correlación directa con la mortalidad (24,5 [9,2-39,7] vs. 59,4 [53,4-65,4]; p<0,01, AUC 0,79 [0,65-0,92]).

Conclusión

El trasplante hepático es un estímulo inflamatorio intenso que se acompaña de niveles elevados de PCR. Un ascenso truncado de la PCR, en el primer día del postoperatorio de trasplante hepático, puede ser un marcador de funcionamiento inadecuado del injerto hepático y está relacionado con la mortalidad intrahospitalaria.

Palabras clave:
Proteína C reactiva
Biomarcador
Disfunción temprana del injerto
Disfunción primaria del injerto
Resultado
Complicación postoperatoria
Pruebas de función hepática

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