ArticleIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine2026
Dynamic Changes in C-reactive Protein and Procalcitonin as Predictors of 28-day Mortality in Acute-on-chronic Liver Failure: A Prospective Observational Study from Northeast India.
Article in Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: Acute-on-chronic liver failure (ACLF) carries a 28-day mortality of 30-55%, driven largely by systemic inflammation that is not captured by model for end-stage liver disease-sodium (MELD-Na) or chronic liver failure consortium ACLF (CLIF-C ACLF) scores. We evaluated whether serial measurements of C-reactive protein (CRP) and procalcitonin (PCT), and their 48- to 72-hour dynamic changes, predict 28-day mortality in critically ill ACLF patients. Patients and methods: Prospective observational study of 70 consecutive ACLF patients [European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria] at a tertiary intensive care unit (ICU) in Northeast India (October 2024-September 2025). C-reactive protein and PCT were measured at day 1 and day 3 (48-72 hours); ΔCRP and ΔPCT were calculated and analyzed against ACLF grade, severity scores, and 28-day outcome. Receiver operating characteristic (ROC) analysis with DeLong 95% confidence intervals (CIs) and multivariable logistic regression were performed. Results: Mean age was 42.2 ± 9.6 years; 88.6% were male; alcohol-related liver disease accounted for 68.6%; grade III ACLF was present in 48.6%. Overall 28-day mortality was 55.7% (82.4% in grade III). Day 3 values and dynamic changes were more discriminative than baseline values. For 28-day mortality, ΔCRP achieved an area under the curve (AUC) of 0.845 (95% CI 0.741-0.950) and ΔPCT 0.810 (95% CI 0.699-0.920), both substantially exceeding admission CRP (0.712, 95% CI 0.587-0.837), admission PCT (0.671, 95% CI 0.541-0.800), MELD-Na (0.611, 95% CI 0.474-0.748), and CLIF-C ACLF (0.637, 95% CI 0.506-0.767). On multivariable logistic regression, ΔCRP [odds ratio (OR) 2.19, 95% CI 1.15-4.16; Conclusions: Dynamic 48- to 72-hour changes in CRP and PCT outperform single admission values and conventional scores in predicting 28-day mortality in ACLF, providing a practical, low-cost prognostic adjunct for the ICU. How to cite this article: Saravanamuthu PK, Das AK, Rajkakati R, Sonowal A. Dynamic Changes in C-reactive Protein and Procalcitonin as Predictors of 28-day Mortality in Acute-on-chronic Liver Failure: A Prospective Observational Study from Northeast India. Indian J Crit Care Med 2026;30(8):650-655.
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