Biomarkers for Diagnosis of Sepsis in Patients with Liver Cirrhosis

Background Patients with liver cirrhosis show immune dysfunction and bacterial translocation. The overall mortality rate of septic shock remains particularly high in cirrhotic patients, ranging from 60 % to 100 %. It is difficult to predict sepsis in patients with cirrhosis because cirrhosis itself can lead to clinical presentation of sepsis. The levels of C-reactive protein and Procalcitonin in patients with liver cirrhosis correlate moderately with the severity of infection. Thus, new diagnostic tools are needed.

Methods The aim of the study was to evaluate the serum levels of Presepsin, Calprotectin and S100A12 protein in patients with liver cirrhosis and sepsis. The study was initiated in August 2018 and is still ongoing. We took blood samples from patients with different causes of sepsis and performed Enzyme-linked Immunosorbent Assays (ELISA). Blood samples were taken within 24h after admission on the intensive care unit at the University Hospital Regensburg, Germany. Until now we have 79 blood samples from patients with different causes of sepsis archived. Besides other comorbidities, liver cirrhosis was present in almost 50 % of the cohort (31 patients). We compared our values with the standard values of Presepsin, Calprotectin and S100A12. Furthermore, we compared the values of the three blood markers in patients with and without liver cirrhosis.

Results Patients with sepsis and liver cirrhosis in our cohort had significantly lower Calprotectin, S100A12 and Presepsin values compared to septic patients without cirrhosis. Concerning Calprotectin only 38 % (12 Patients) of patients with liver cirrhosis and sepsis had higher levels of serum calprotectin compared to the normal values. The S100A12 protein showed also weak abilities to diagnose sepsis in patients with liver cirrhosis. All the values were in the normal range.

Regarding Presepsin, 99 % of septic patients (with and without liver cirrhosis) had higher serum levels and all septic patients with liver cirrhosis had higher levels of serum presepsin compared to the normal values.

Conclusion In our cohort Calprotectin and the S100A12 protein were less suitable to diagnose sepsis in patients with liver cirrhosis. However, Presepsin was an excellent marker for the detection of sepsis not only in patients with liver cirrhosis but also in patients without cirrhosis.

Thus, Presepsin could be beneficial in daily clinical practice in diagnosis of sepsis, even in patients with liver cirrhosis.

Publication History

Article published online:
04 January 2021