Sepsis in liver failure patients: Diagnostic challenges and recent advancements

Table 2 Studies on biomarkers of sepsispatients within acute liver failure or acute-on-chronic liver failure

Ref.	Country	Patients	Biomarker(s)	Results and remarks
Silvestre et al[50], 2010	Europe	ALF	CRP	CRP levels are markedly decreased in ALF, even in presence of sepsis
Igna et al[62], 2022	Europe	ACLF	Presepsin, PCT and CRP	Presepsin, CRP, and PCT levels were higher in sepsis patients. Presepsin ≥ 2300 pg/mL had excellent (AUROC 0.95) for sepsis
Rule et al[55], 2015	USA	ALF	PCT	PCT levels > 2.0 ng/mL could not differentiate ALF patients with or without BIs
Huang et al[68], 2017	China	ACLF	Prostaglandin E2	Serum Prostaglandin E2 Level 141pg/mL predicted infection with AUROC curve of 0.83
Chen et al[48], 2021	China	ACLF	sTREM-1, Presepsin, and PCT	sTREM-1 and presepsin were significantly higher in sepsis patients, with higher accuracy compared to CRP and PCT
Cavazza et al[63], 2024	United States	ALF	sCD206	sCD206, a soluble markers of macrophage activation, independently predictedinfection
Yadav et al[69], 2022	India	ACLF	IL-1Ra, IL-18, TREM1, PD-L1, and TIM3	Higher baseline and rising levels of IL-1Ra, IL-18, TREM1 soluble factors, and suppressive monocytes (PDL1+ve, TIM3+ve)predictedrisk of sepsis within 72 hours
Lin et al[57], 2020	China	ACLF	PCT, neutrophils% and CRP	The AUROC of the infection score,comprisingPCT, neutrophils% and CRP, for discriminatingBI was 0.740
Yuet al[80], 2024	China	ACLF	BTLA	BTLA levels, a member of the CD28Igsuperfamily, significantly increased in the CD4+ T cells andwere positively correlated with infection complications

ALF: Acute liver failure; ACLF: Acute-on-chronic liver failure; AUROC: Area under receiver operating characteristic curve; BI: Bacterial infection; CRP: C-reactive protein; PCT: Procalcitonin; IL-1Ra: Interleukin-1 receptor antagonist; IL-18: Interleukin-18; TREM1: Triggering receptor expressed on myeloid cells 1; PD-L1: Programmed death ligand 1; TIM3: T-cell immunoglobulin and mucin domain-containing protein 3; BTLA: B- and T-lymphocyte attenuator.