Postoperative Sepsis In Patients Research Articles

Role of pre-operative fecal calprotectin in predicting post-operative sepsis in patients undergoing liver transplantation

Role of pre-operative fecal calprotectin in predicting post-operative sepsis in patients undergoing liver transplantation

Risk Factors for Sepsis in Postoperative Patients

Sepsis is a severe acute infection that can lead to organ failure and mortality in 30-50% of patients. It ranks among the top 10 causes of mortality in the United States and has increased significantly since the 1970s. Postoperative sepsis, the primary type of sepsis, accounts for almost one-third of all sepsis cases. Postoperative sepsis is a major cause of illness and death for hospitalized patients, often leading to multiple organ failure and mortality. A study found that patients aged 18 years or older who have undergone surgical interventions and have been hospitalized for at least 4 days after the operation have a higher likelihood of developing sepsis. The most prevalent complication after radical gastrectomy for stomach cancer is postoperative infection, which occurs through leukocyte depletion in transfusion patient. Being male or over 65 significantly increased the likelihood of having postoperative sepsis. Sex hormones significantly influence the body's response to sepsis, and elderly individuals may be more susceptible due to deterioration of immune system function and age-related immunosenescence. Chronic renal illness, diabetes, and chronic heart failure have the highest risks of developing postoperative sepsis, ranked first, second, and third, respectively. Dysfunctions in the cardiovascular and hematological systems also have the highest probability of leading to the development of postoperative sepsis. These findings suggest potential areas for future research to decrease the impact of the disease.

10541 Preoperative Blood Biomarker Predictors of Postoperative Sepsis in Patients Undergoing Bilateral Salpingo-Oophorectomy

10541 Preoperative Blood Biomarker Predictors of Postoperative Sepsis in Patients Undergoing Bilateral Salpingo-Oophorectomy

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review.

Systemic inflammatory response syndrome (SIRS) and sepsis are inflammatory responsesto infection or trauma, causing symptoms and adverse outcomes such as organ shutdown and death. Different scoring systems can help in the diagnosis of SIRS and sepsis. Several biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and white blood cells (WBCs) can serve as predictors of sepsis. Surgery, trauma, and burns are the non-inflammatory causes of SIRS and sepsis. In postoperative patients, both inflammatory and non-inflammatory causes of immune response may co-exist. The role of inflammatory biomarkers in identifying sepsis development, deciding to use antibiotics, and discharging patients needs further exploration and clarity. We searched medical databases such as PubMed/Medline, PMC, ScienceDirect, Cochrane Library, and Google Scholar for relevant medical literature. The identified papers were screened, eligibility criteria were applied, and 15 research papers were identified. The finalized papers explored the roles of CRP and PCT in postoperative patients. Both CRP and PCT are raised in a postoperative patient, and then, gradually, the levels decrease. However, in case of an infection, these levels continue to rise and signify an infection, which may progress to sepsis. The cut-off values can guide decision-making about when to start antibiotics and discharge the patient. PCT was found to be more reliable in identifying the infection and preventing the development of sepsis. Further research is needed to identify the exact cut-off values that can help in decision-making.

EP.TH.756Post-operative sepsis: Is CT reliable in diagnosing the cause of post-operative sepsis?

Abstract Aim To assess the reliability of computerised tomography in post-operative sepsis in patients who previously underwent laparotomy in the same hospital admission. Introduction Method This study was done on re-operations following an abdominal operation from April 2012 to April 2016 at a district general hospital. Data regarding demography, initial operation, post-operative problems, pre-operative diagnosis, and use of computed tomography, the findings on CT, and operative findings were collected. A comparison was made between the CT findings and findings on re-laparotomy. Also noted was the number of patients who did not have a re-laparotomy following CT. Result There were 87 patients, of whom, 10 had no accessible notes and were removed from the list. Of the remaining 77, 53(68.8%) had CT scans, 24 did not (31.2%). Of these that had CT, 29 (54.7%) had findings which matched with intra-operative findings on re-laparotomy, in 12 (22.6%) CT findings did not match 4(7.5%) had minor findings not needing surgery and 8(15.5%) had normal or insignificant findings. Conclusions We found in this study that, CT did have a significant contributory role in the arsenal of methods to aid source control in those patients that are septic following an abdominal operation, and this should be used as a pre-operative diagnostic modality.

Nomograms Predicting the Occurrence of Sepsis in Patients following Major Hepatobiliary and Pancreatic Surgery

Purpose Sepsis is a severe complication in patients following major hepatobiliary and pancreatic surgery. The purpose of this study was to develop and validate a nomogram based on inflammation biomarkers and clinical characteristics. Methods Patients who underwent major hepatobiliary and pancreatic surgery between June 2015 and April 2017 were retrospectively collected. Multivariate logistic regression was used to identify the independent risk factors associated with postoperative sepsis. A training cohort of 522 patients in an earlier period was used to develop the prediction models, and a validation cohort of 136 patients thereafter was used to validate the nomograms. Results Sepsis developed in 55 of 522 patients of the training cohort and 19 of 136 patients in the validation cohort, respectively. In the training cohort, one nomogram based on clinical characteristics was developed. The clinical independent risk factors for postoperative sepsis include perioperative blood transfusion, diabetes, operative time, direct bilirubin, and BMI. Another nomogram was based on both clinical characteristics and inflammation biomarkers. Multivariate regression analyses showed that previous clinical risk factors, PCT, and CRP were independent risk factors for postoperative sepsis. The last nomogram showed a good C-index of 0.844 (95% CI, 0.787-0.900) compared with the previous one of 0.777 (95% CI, 0.713-0.840). Patients with a total score more than 109 in the second model are at high risk. The positive predictive value and negative predictive value of the second nomogram were 27% and 97%, respectively. Conclusion The nomogram achieved good performances for predicting postoperative sepsis in patients by combining clinical and inflammation risk factors. This model can provide the early risk estimation of sepsis for patients following major hepatobiliary and pancreatic surgery.

Bowel preparation in elective colorectal surgery: is mechanical bowel preparation necessary?

The topic of bowel cleansing with mechanical bowel preparation or oral antibiotics before elective colorectal surgery is highly contentious. Historically, a combination of mechanical bowel preparation and oral antibiotics has been used since the publication of a randomised controlled trial by Rosenberg and colleagues1 in 1971 that showed a significant reduction in rates of surgical-site infection, anastomotic leak, and overall postoperative sepsis in patients having large bowel resection. However, the use of preoperative oral antibiotics is no longer as well favoured.

Predicting and comparing postoperative infections in different stratification following PCNL based on nomograms

To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (PCNL) through predicting and comparing post-PCNL infections based on nomograms, a retrospective cohort study was conducted among 969 cases who underwent PCNL from Dec 5, 2016 to Dec 25, 2017 in Kunming, Yunnan Province. We examined clinical features, urine routine, blood routine, blood biochemistry, imaging studies and operative information and recorded the examination results before surgery for univariate and multivariate logistic regression. We applied receiver operating characteristic curves, calibration curves, accuracy, specificity, sensitivity, positive predictive value and negative predictive value to evaluate and compare the models. Nomograms were used to visualize the different degrees of postoperative infection complications. The risk scores of the three groups were compared by diabetes mellitus distribution. Our results suggest that the more severe the infection is, the more accurate the model predicts and that the occurrence of severe infection mostly is related to the patients' homeostasis. Hence, we developed an online post-PCNL sepsis dynamic nomogram which can achieve visualization and dynamically predict the incidence of sepsis in postoperative patients.

Risk factors for postoperative sepsis in patients with gastrointestinal perforation.

BACKGROUNDSepsis is fatal in patients with gastrointestinal perforation (GIP). However, few studies have focused on this issue.AIMTo investigate the risk factors for postoperative sepsis in patients with GIP.METHODSThis was a retrospective study performed at the Department of General Surgery in our treatment center. From January 2016 to December 2018, the medical records of patients with GIP who underwent emergency surgery were reviewed. Patients younger than 17 years or who did not undergo surgical treatment were excluded. The patients were divided into the postoperative sepsis group and the non-postoperative sepsis group. Clinical data for both groups were collected and compared, and the risk factors for postoperative sepsis were investigated. The institutional ethical committee of our hospital approved the study.RESULTSTwo hundred twenty-six patients were admitted to our department with GIP. Fourteen patients were excluded: Four were under 17 years old, and 10 did not undergo emergency surgery due to high surgical risk and/or disagreement with the patients and their family members. Two hundred twelve patients were finally enrolled in the study; 161 were men, and 51 were women. The average age was 62.98 ± 15.65 years. Postoperative sepsis occurred in 48 cases. The prevalence of postoperative sepsis was 22.6% [95% confidence interval (CI): 17.0%-28.3%]. Twenty-eight patients (13.21%) died after emergency surgery. Multiple logistic regression analysis confirmed that the time interval from abdominal pain to emergency surgery [odds ratio (OR) = 1.021, 95%CI: 1.005-1.038, P = 0.006], colonic perforation (OR = 2.761, CI: 1.821–14.776, P = 0.007), perforation diameter (OR = 1.062, 95%CI: 1.007-1.121, P = 0.027), and incidence of malignant tumor-related perforation (OR = 5.384, 95%CI: 1.762-32.844, P = 0.021) were associated with postoperative sepsis.CONCLUSIONThe time interval from abdominal pain to surgery, colonic perforation, diameter of perforation, and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.

Preoperative Mean Platelet Volume and Platelet Distribution Width Predict Postoperative Sepsis in Patients with Colorectal Cancer.

Purpose Mean platelet volume (MPV) and platelet distribution width (PDW) have been used to reflect the platelet activity in clinics. We assessed initial serum MPV and PDW levels in colorectal cancer (CRC) patients, in predicting the development of sepsis in CRC patients postoperatively. Patients and Methods This study included 220 patients diagnosed with CRC. 55 patients were stratified to one group that developed sepsis postoperatively, and 165 patients were stratified to the other group that did not develop sepsis postoperatively. Clinical and laboratory characteristics were collected 3 days before the operation. Results MPV (p < 0.001) was significantly higher and PDW (p < 0.001) was significantly lower in the sepsis group than in the nonsepsis group. Either MPV or PDW is independently associated with ICU mortality in sepsis patients with CRC. MPV is independently associated with 14-day, 28-day, and 90-day mortality and PDW is independently associated with 90-day mortality in patients with CRC. The prevalence of sepsis increased as MPV tertiles increased (p < 0.001), and the prevalence of sepsis increased as PDW tertiles decreased (p < 0.001). Conclusions Serum MPV and PDW levels between CRC patients with/without sepsis postoperatively are significantly different. The initial serum MPV or PDW levels can potentially serve as a predictor of sepsis in CRC patients postoperatively.

Respiratory Disorder at the End of Surgery for Peritonitis Due to Colorectal Perforation Is a Critical Predictor of Postoperative Sepsis.

The aim of this study was to identify a critical predictor of postoperative sepsis in patients with peritonitis due to colorectal perforation. Between 2009 and 2014, fifty-three patients who underwent emergency surgery for peritonitis due to colorectal perforation in our hospital were examined retrospectively to identify the critical predictor of postoperative sepsis. Between 2016 and 2017, twelve patients with peritonitis due to colorectal perforation were enrolled in a prospective study to validate the critical predictor obtained by the previous retrospective study. Mechanical ventilation for more than two days after surgery seemed to be a critical predictor of postoperative sepsis. In the prospective study, six patients who were withdrawn from mechanical ventilation within one day after surgery did not develop sepsis. Respiratory disorders at the end of surgery for peritonitis due to colorectal perforation seem to be a critical predictor of postoperative sepsis.

The Role of Probiotics and Synbiotics in Preventing Postoperative Sepsis in Gastrointestinal Surgery

Sepsis is a potentially fatal condition, accounting for over 1 million hospitalizations annually in the United States, with mortality rates as high as 40%. Patients undergoing gastrointestinal (GI) surgery are especially susceptible to sepsis, due to bacterial translocation secondary to surgical trauma and the use of antibiotics. Probiotics and synbiotics, which have been hypothesized to counteract disturbances in the intestinal flora and reduce pathogenic bacterial colonization, have been proposed for the prevention and treatment of a variety of GI conditions, including sepsis. Recent randomized control trials and meta-analyses evaluating the use of probiotic/symbiotic supplementation in elective surgical patients have demonstrated a significant reduction in the risk of developing postoperative sepsis in patients with the use of probiotic/synbiotics. Coupled with the prevention of numerous other GI symptoms, such as diarrhea, probiotics should be considered in all elective surgical GI patients.

Significance of preoperative neutrophil–lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy

We evaluated the usefulness of preoperative neutrophil–lymphocyte count ratio (NLCR) in predicting postoperative sepsis after percutaneous nephrolithotomy (PCNL). In total, 487 patients who underwent PCNL for renal stones were included in the present retrospective study. The stone burden, number of tracts and location, operation time, fluoroscopy time, presence of residual stones, and blood transfusion rates were postoperatively recorded in all patients. All patients were followed up for signs of systemic inflammatory response syndrome (SIRS) and sepsis. The association of sepsis/SIRS with the risk factors of infectious complications, including NLCR, was evaluated. SIRS was detected in 91 (18.7%) patients, 25 (5.1%) of whom were diagnosed with sepsis. Stone burden, operation time, irrigation rate, previous surgery, nephrostomy time, access number, blood transfusion, residual stone, postoperative urinary culture, renal pelvis urinary culture, and stone culture were found to be predictive factors for SIRS and sepsis development. Receiver operating characteristic curve analysis revealed an NLCR cutoff of 2.50 for predicting the occurrence of SIRS/sepsis. We found that the incidence of sepsis was significantly higher in patients with NLCR ≥ 2.50 than in patients with NLCR < 2.50 (p = 0.006). Preoperative and postoperative urine culture positivity were associated with high NLCR (p = 0.039 and p = 0.003, respectively). We believe that preoperative NLCR may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones. This marker is simple, easily measured, and easy to use in daily practice without extra costs.

Probiotics and Synbiotics Decrease Postoperative Sepsis in Elective Gastrointestinal Surgical Patients: a Meta-Analysis

BackgroundThe health benefits of probiotics and synbiotics are well established in healthy adults, but their role in preventing postoperative sepsis remains controversial. This meta-analysis assesses the impact of probiotics and synbiotics on the incidence of postoperative sepsis in gastrointestinal (GI) surgical patients. MethodsA comprehensive literature search of all published randomized control trials (RCTs) was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2015). Inclusion criteria included RCTs comparing the use of any strain or dose of a specified probiotic/synbiotic with placebo or a “no treatment” control group. The incidence of postoperative sepsis (within 1 month of surgery) and postoperative mortality were analyzed. ResultsFifteen RCTs involving 1201 patients (192 receiving probiotics, 413 receiving synbiotics, and 596 receiving placebo) were analyzed. Overall, probiotic and synbiotic uses significantly reduced the risk of developing postoperative sepsis by 38 % (relative risk (RR) = 0.62, 95 % confidence interval (CI) 0.52–0.74, p < 0.001). ConclusionsThe use of probiotic/synbiotic supplementation is associated with a significant reduction in the risk of developing postoperative sepsis in patients undergoing elective GI surgery. Probiotic/synbiotic supplementation is a valuable adjunct in the care of patients undergoing GI surgery. Additional studies are required to determine the optimal dose and strain of probiotic/synbiotic.

A study on positive stone culture and its association with rate of sepsis after urological procedures

Background: This prospective study is carried out to determine if there is a correlation between urine and/or stone cultures with postoperative sepsis in patients treated for renal and ureteral calculi. And to determine the correlation between different sites of urine sampling, including stones, and also ascertained which is more predictive of urosepsis. Correlation of urosepsis with prognosis and final outcome of patients of urolithiasis. Methods: This prospective study was carried out in Department of surgery, Gandhi medical collage Bhopal and associated Hamidia hospital Bhopal between July 2013 to October 2014. All patients are divided in 4 groups according to their diagnosis. Results: The incidence of renal stone was more in male (N 67) (67%) as compared with female (N 33) (33%) i.e., in the ratio of 2:1. Out of 100 patients 45 cases showed infection in preoperative urine culture, while rest 55 were sterile. Similarly 65 patients were positive for stone culture and rest 35 were sterile. 30 patients had both stone and urine culture positive. Infected urine was more common in females (66.67%). Most common bacteria isolated in urine culture were E. coli (24.44%), Klebsiella (17.77%). While correlating the result of concurrent bacteriological analysis of stones and urine culture, it is evident that same organisms from urine culture and stone culture were isolated in 8 (17.77% of positive urine culture) cases but different organisms in 26 (57.77% positive urine culture) cases. Post operatively 37% (N 37) patient show signs of SIRS out of which 17 patients had both preoperative urine and post-operative stone core culture positive. 14 Patient had only stone core culture positive, 5 pt had only urine culture positivity, and in one patient both culture were negative. Out of 37 patients who had sepsis 31 patients were positive for stone culture while 23 patients were positive for urine culture. The result was significant on chi square test (Observed P value is 0.036). Conclusions: The results of this study suggest that in patients undergoing surgery for urolithiasis, stone cultures are better predictors of urosepsis than bladder urine C and S. Positive stone culture may guide clinicians regarding selection of antibiotics, especially in cases of severe urosepsis.

Positive stone culture is associated with a higher rate of sepsis after endourological procedures

The purpose of this study was to determine if there is a correlation between urine and/or stone cultures with postoperative sepsis in patients treated for renal and ureteral calculi. Three hundred and twenty-eight consecutive patients who underwent percutaneous nephrolithotomy (PCNL) or ureteroscopy from 2006 to 2009 were identified, all of whom had a stone culture obtained during surgery. All had a preoperative urine culture. Two hundred and seventy-four underwent ureteroscopy and 54 PCNL. All patients had either negative preoperative urine cultures or were given preoperative antibiotics for 1-7days prior to surgery. Stone fragments were obtained during the procedure and sent for analysis. The primary endpoint was sepsis. Of 328 patients, 3% (11/328) developed postoperative sepsis. 73% (8/11) had positive stone cultures, while none had a positive preoperative urine culture. 8% (8/96) with positive stone cultures and 1% (3/232) with negative stone cultures developed sepsis (p=0.003). The stone culture grew the same pathogen as the urine culture obtained on readmission in 64% (7/11) of the patients, while 9% (1/11) of preoperative urine cultures correlated with the readmission pathogen (p=0.02). The pathogen causing infection had a significantly higher correlation with the organism grown on stone culture than the preoperative urine culture. The patients who developed sepsis did so despite preoperative antibiotics, and the pathogen grown on the preoperative urine culture was different from that seen post operatively. These results suggest that stone culture is more informative than preoperative urine culture for determining treatment of postoperative sepsis.

Outcome of Anastomotic Leakage after Colorectal Surgery in Patients with or without Preoperative Mechanical Bowel Irrigation: An Observational Study

Background: Randomized controlled trials have demonstrated that the rate of anastomotic leakage after laparoscopic colorectal surgery does not differ between patients with or without preoperative bowel preparation. There is, however, still an ongoing discussion that infectious complications consequential to anastomotic leakage, in particular sepsis, are more severe in patients without preoperative bowel cleaning. The aim of this study is to evaluate the assumption that postoperative sepsis in patients undergoing colorectal surgery without mechanical preoperative bowel irrigation is more severe compared to patients with bowel preparation. Methods: In the surgical unit in a teaching hospital in Zurich pa- tients undergoing laparoscopic colorectal surgery were consecutively included in the study. 367 patients with colorectal surgery between December 2000 and April 2004 underwent preoperative mechanical bowel irrigation. From May 2004 until April 2008 colorectal surgery was performed in 367 patients without bowel irrigation. Outcomes of interest are: Severity of sepsis in patients with postoperative anastomotic leakage, assessed by the necessity of referral to ICU, length of stay in the ICU and total length of hospital stay. Results: 734 patients were included in the study, 367 patients with and 367 without preoperative bowel preparation. In 43 patients an anastomotic insufficiency was diagnosed, 26 in the group with and in 17 patients without preoperative irrigation. 14 of these cases developed sepsis and were referred to ICU, 8 (31%) in the group with and 6 (35%) in the group without preparative irrigation. Between the two groups there were no significant differences in mortality, length of stay on ICU and total length of hospital stay. Conclusions: The results of our study provide no indication that the course of sepsis, associated with anastomotic leakage after laparoscopic colorectal surgery, is more severe in patients without preoperative bowel preparation, compared to those with bowel cleaning.

Preoperative CD4 Count or CD4/CD8 Ratio as a Useful Indicator for Postoperative Sepsis in HIV-Infected Patients Undergoing Abdominal Operations

CD4 count or CD4/CD8 ratio has been found to be a valuable marker of disease progression in HIV and AIDS. Our objective was to evaluate preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations. Retrospective analysis of 35 HIV-infected patients (four females, 31 males) undergoing abdominal operations. All patients were divided into postoperative sepsis group (A) and non-sepsis group (B). Demographic and clinical information were entered into a database and included: type of surgical procedure, age, peripheral blood cells, plasma albumin, CD4 counts, and CD4/CD8 ratios. Furthermore, we stratified and compared the incidence of postoperative sepsis according to the preoperative CD4 counts with breakpoint value of 200 cells/μL and preoperative CD4/CD8 ratios with breakpoint value of 0.15. Overall postoperative sepsis morbidity in our study was 51.43% (18/35). In sepsis group, the mean preoperative and postoperative CD4 counts, CD4/CD8 ratios, and postoperative platelet count were found significantly lower, respectively, than those in non-sepsis group (P < 0.05). The incidence of postoperative sepsis in the patients with preoperative CD4 counts ≤ 200 cells/μL was markedly higher than those with CD4 counts > 200 cells/μL (83.3% versus 17.65%; P = 0.000). Likewise, the incidence of postoperative sepsis in the patients with preoperative CD4/CD8 ratios ≤ 0.15 was dramatically higher than those with CD4/CD8 ratios > 0.15 (90% versus 36%; P = 0.007). Our preliminary study showed that HIV-infected patients with preoperative CD4 count ≤ 200 cells/μL or CD4/CD8 ratio ≤ 0.15 had overall higher postoperative sepsis morbidity. Preoperative CD4 count or CD4/CD8 ratio may be used as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations.

Predictive value of immunological parameters on sepsis following abdominal operation for patients with HIV infection

To study postoperative sepsis in HIV/AIDS patients who underwent abdominal operations. A retrospective analysis was performed to study 34 HIV/AIDS patients treated between January 2009 and December 2010 at the Shanghai Public Health Clinical Center Affiliated to Fudan University. There were 31 males and 3 females in this cohort with a mean age of 45±13 years. Nineteen patients developed postoperative sepsis. The levels of preoperative CD4, postoperative CD4, preoperative CD4/CD8, and postoperative platelet were significantly lower than those without sepsis (all P<0.05). Among 19 patients with a preoperative CD4 cell count less than or equal to 200×10(6)/L, the incidence of postoperative sepsis rate was 84.2%(16/19), and for those with a preoperative CD4 cell count greater than 200×10(6)/L, the incidence of postoperative sepsis rate was 20.0%(3/15), the difference was statistically significant(P<0.05). There were 3 postoperative deaths. CD4 cell count can be used as a predictive marker for the development of postoperative sepsis in patients with HIV/AIDS.

Plasma Proteome to Look for Diagnostic Biomarkers of Early Bacterial Sepsis after Liver Transplantation

While outcome continuously improves after liver transplantation, sepsis remains the leading cause of early postoperative mortality. Diagnosis of infections remains particularly difficult in these patients. This study used plasma profiling coupling Proteinchip array with surface-enhanced laser desorption ionization time-of-fly mass spectrometry to search for biomarkers of postoperative sepsis in patients who underwent liver transplantation. Diagnosis of sepsis at day 5 relied on widely accepted clinical signs and positive culture of microbiologic samples. Profiles of day 5 plasma were obtained from SELDI-TOF CM10 chip (BioRad, Marnes-la-Coquette, France) analysis. Mean peak intensity of proteins was compared between septic and nonseptic plasma by U test followed by analysis of the area under the receiver-operating characteristic for the significant peaks. Diagnostic performance of significant proteins was established in a derivation set and in a validation set. In the derivation set of 31 patients with and 30 without infection, 23 plasma protein peaks were differentially expressed between patients with and without sepsis. Combination of five peaks allowed sepsis diagnosis with a positive likelihood ratio of 12.5 and a C-statistics of 0.72, 95% CI 0.57-0.85. In the validation set of 31 patients with infection and 34 without infection, the five peaks were differentially expressed as well and allowed day 5 sepsis diagnosis with a positive likelihood ratio of 5.1 and C-statistics of 0.74 (0.58-0.85). A combination of five plasma protein peaks may provide material for useful diagnostic biomarkers of postoperative sepsis in patients undergoing liver transplantation. However, these proteins remain to be identified.