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

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.