Procalcitonin, a Biomarker for Diagnosing and Differentiating Infection among Liver Transplant Recipients: a systematic review and meta-analysis

Background: Infection has long been the major cause for death after liver transplantation. Diagnosing this deadly disease in time can be of great help to support the patients in intensive care units. However, tests like blood culture would take too much time to generate an outcome. Procalcitonin seems to be a promising biomarker in such clinical settings these days. To evaluate its diagnostic value as a biomarker in identifying and differentiating infectious complications in liver transplant recipients. Methods PUBMED, Scopus, Web of Science, Cochrane Library were searched for articles published from January 1990 to September 2019 without language limitation. Cohort or case-control study investigating the value of PCT in distinguishing postoperative infectious complications among liver transplant recipients were included, followed by measurement using QUADAS-2 tool to estimate the risk of bias of each study. Bivariate approach and random-effects model were performed to generate the pooled outcomes. Results 8 studies (studying 560 liver transplant recipients) from 6 populations were reviewed and included, one of which is later excluded due to huge heterogeneity it caused. No significant threshold effect was found, suggesting that heterogeneity returned by the I 2 was not due the various cutoff values. The pooled DOR was 18.65 (95%CI 9.85-35.31) and the area under HSROC was 0.857 ( θ =-0.024; β =-0.203). The positive likelihood ratio and negative likelihood ratio are 3.472 (95% 2.352-5.127) and 0.289 (95% 0.192-0.434). Conclusion Current articles suggest a reasonable diagnostic value for the procalcitonin test in identifying infectious complications among patients undergoing liver transplantation. However, the reason why no threshold effect was found remained explored.