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Peer-reviewedCC BY 4.0PLOS One

Serum procalcitonin as an early marker associated with postoperative complications following liver resection: A prospective observational study

  • Mohammad Saydul Aman1
  • Md. Shawkat Ali2
  • Bishow Raj Khadka3
  • Bineet Kumar Yadav4
  • Bidhan Chandra Das5
  • Md Foyjul Islam6
6 affiliations
  1. 1Department of Surgical Gastroenterology, National Gastroliver Institute and Hospital, Dhaka, Bangladesh
  2. 2Department of Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh
  3. 3Department of General Surgery, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Bagmati, Nepal
  4. 4Department of General Surgery, Nobel Medical College Teaching Hospital Ltd., Morang, Nepal
  5. 5Department of Hepatobiliary, Pancreatic, and Liver Transplantation Surgery, Bangladesh Medical University, Dhaka, Bangladesh
  6. 6Department of Epidemiology, Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
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Abstract

Postoperative complications (POC) following liver resection (LR) can significantly affect patient outcomes, and early predictors are crucial for timely intervention, particularly in resource-limited settings such as Bangladesh. In this prospective observational study conducted from August 2021 to July 2022, 42 patients undergoing LR were enrolled and divided into two groups based on the presence (n = 22) or absence (n = 20) of POC. Serum procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein (CRP) were measured on the first, third, and seventh postoperative days (POD). Median serum PCT levels were significantly higher in patients with POC on all PODs (POD1: 1.71 vs. 0.53 µg/L, p = 0.001; POD3: 0.69 vs. 0.23 µg/L, p = 0.001; POD7: 0.48 vs. 0.10 µg/L, p = 0.003), whereas WBC and CRP did not differ between groups. The area under the receiver operating characteristic curve (AUC) for serum PCT was 0.798 (95% CI: 0.655–0.927), 0.797 (95% CI: 0.648–0.920), and 0.769 (95% CI: 0.614–0.898) on POD1, POD3, and POD7, respectively, indicating that POD1 serum PCT showed moderate discriminatory ability for the broad composite endpoint. Using the Youden index, the optimal POD1 serum PCT cutoff value was identified as 1.240 µg/L, which achieved 86.4% sensitivity and 70.0% specificity. In exploratory multivariable analysis, higher POD1 serum PCT was associated with postoperative complications after adjustment for prespecified covariates (adjusted OR: 12.30; 95% CI: 1.44–104.89; p = 0.022); however, the wide confidence interval and small number of events warrant cautious interpretation. Sensitivity analyses showed reduced discrimination for Clavien–Dindo grade ≥II (AUC: 0.650) and grade ≥III complications (AUC: 0.581), indicating limited discriminatory ability for severe morbidity in this dataset. These findings suggest that POD1 PCT may support early postoperative risk stratification, but its clinical utility, particularly for severe morbidity, requires validation in larger studies.

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Cite

BibTeXRIS
BibTeX
@article{aman2026serum,
  title = {{Serum procalcitonin as an early marker associated with postoperative complications following liver resection: A prospective observational study}},
  author = {Mohammad Saydul Aman and Md. Shawkat Ali and Bishow Raj Khadka and Bineet Kumar Yadav and Bidhan Chandra Das and Md Foyjul Islam},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0338171},
  url = {https://doi.org/10.1371/journal.pone.0338171},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Serum procalcitonin as an early marker associated with postoperative complications following liver resection: A prospective observational study
AU  - Mohammad Saydul Aman
AU  - Md. Shawkat Ali
AU  - Bishow Raj Khadka
AU  - Bineet Kumar Yadav
AU  - Bidhan Chandra Das
AU  - Md Foyjul Islam
PY  - 2026
DA  - 2026/09/23
JO  - PLOS One
DO  - 10.1371/journal.pone.0338171
UR  - https://doi.org/10.1371/journal.pone.0338171
AB  - Postoperative complications (POC) following liver resection (LR) can significantly affect patient outcomes, and early predictors are crucial for timely intervention, particularly in resource-limited settings such as Bangladesh. In this prospective observational study conducted from August 2021 to July 2022, 42 patients undergoing LR were enrolled and divided into two groups based on the presence (n = 22) or absence (n = 20) of POC. Serum procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein (CRP) were measured on the first, third, and seventh postoperative days (POD). Median serum PCT levels were significantly higher in patients with POC on all PODs (POD1: 1.71 vs. 0.53 µg/L, p = 0.001; POD3: 0.69 vs. 0.23 µg/L, p = 0.001; POD7: 0.48 vs. 0.10 µg/L, p = 0.003), whereas WBC and CRP did not differ between groups. The area under the receiver operating characteristic curve (AUC) for serum PCT was 0.798 (95% CI: 0.655–0.927), 0.797 (95% CI: 0.648–0.920), and 0.769 (95% CI: 0.614–0.898) on POD1, POD3, and POD7, respectively, indicating that POD1 serum PCT showed moderate discriminatory ability for the broad composite endpoint. Using the Youden index, the optimal POD1 serum PCT cutoff value was identified as 1.240 µg/L, which achieved 86.4% sensitivity and 70.0% specificity. In exploratory multivariable analysis, higher POD1 serum PCT was associated with postoperative complications after adjustment for prespecified covariates (adjusted OR: 12.30; 95% CI: 1.44–104.89; p = 0.022); however, the wide confidence interval and small number of events warrant cautious interpretation. Sensitivity analyses showed reduced discrimination for Clavien–Dindo grade ≥II (AUC: 0.650) and grade ≥III complications (AUC: 0.581), indicating limited discriminatory ability for severe morbidity in this dataset. These findings suggest that POD1 PCT may support early postoperative risk stratification, but its clinical utility, particularly for severe morbidity, requires validation in larger studies.
SN  - 1932-6203
ER  -