토끼유래 항-사람 흉선세포 면역글로불린을 유도면역억제제로 사용한 췌장이식 환자에서 비감염성 원인에 의한 발열과 감염성 원인에 의한 발열의 비교 분석 연구

Abstract

Infectious diseases have been regarded as major problem in solid organ transplantation recipients, resulting in substantial morbidity and mortality, and fever has been regarded as important sign for infectious diseases. But, in fact, having a fever doesn’t always signal infection. Laboratory biomarkers that can differentiate non-infectious fever from infectious fever after pancreas transplantation have yet to be discovered. Non-infectious fever was defined as the presence of fever (> 38.3℃) in the absence of a documented clinical diagnosis of infection or a positive culture. Among 184 consecutive recipients, a total of 91 recipients developed fever within one-month post-transplant, of whom 46 had infectious fever and 45 had non-infectious fever at our center between August 2014 and July 2019. The onset of fever was earlier in the non-infectious fever group (14.4±3.7 post-transplant days) compared with the infectious fever group (16.5±5.8 post-transplant days; P = .033). Multivariate analysis showed that serum procalcitonin at the peak of fever could significantly differentiate infectious fever from non-infectious fever (OR 53.776, 95% CI: 6.824–423.776, P < .001). The area under the curve for differentiating between the two groups was 0.853 (95% CI, 0.780–0.926) for procalcitonin and 0.667 (95% CI, 0.549–0.785) for CRP. The best cut-off values of serum procalcitonin and CRP were 0.405 ng/mL (sensitivity, 77.1%; specificity, 80.8%) and 7.355 mg/dL (sensitivity, 66.7%; specificity, 67.3%), respectively. Serum procalcitonin may be useful for differentiating non-infectious fever from infectious fever after pancreas transplantation