Concentration standardization improves the capacity of drainage CRP and IL-6 to predict surgical site infections

Abstract

The early detection of surgical site infection (SSI) remains an unsolved problem. Inflammatory factors in fluids drained from surgical sites may be a promising tool for predicting SSI. Previous attempts to predict SSI via such factors have not taken baseline concentrations into account. However, this may have comprised predictive efficacy. In the current study, concentrations of C-reactive protein (CRP) and interleukin 6 (IL-6) in fluid samples drained from surgical sites in 20 patients with SSI and 60 matched controls were assessed, and concentrations from day 2 to day 4 were divided by the concentration at day 1 to achieve concentration standardization. There were no significant differences of CRP or IL-6 concentrations at day 1 or day 2 ( p > 0.05), but there were significant differences at day 3 and day 4 ( p < 0.05). The areas under the curve (AUCs) for SSI of standardized concentrations were higher than those of the corresponding absolute concentrations of CRP and IL-6 in fluid drained at days 3 and 4. Standardized concentrations of CRP at day 4 yielded the highest AUC (0.92; 95% confidence interval: 0.84–0.97), with a sensitivity of 90% and specificity of 80% at the best cutoff. Concentration standardization may improve the efficacy of predicting SSI via CRP and IL-6 in fluids drained from surgical sites. Although the sample size was small, the study demonstrated the feasibility of non-invasive, accurate, and early detection of postoperative SSI in a diverse real population. Further studies are needed to validate the results of the present study and investigate their broader applicability. Impact statement The ability to predict surgical site infections (SSIs) early would be advantageous. Previous studies have investigated the use of inflammatory factors in fluids drained from surgical sites to predict SSI, but the diagnostic efficacy of this method requires improvement. Baseline levels of inflammatory factors vary between individuals, but this variation tends to differ in patients with and without SSIs. Therefore, we standardized subsequently acquired concentrations of interleukin 6 and C-reactive protein in fluids drained from surgical sites by dividing them by the concentrations determined at day 1 to preclude the confounding effects of differences in baseline levels. The standardized concentrations had higher predictive efficacy than the absolute concentrations. Standardizing the data rendered SSI prediction more precise and practical in a diverse group of real patients. This translational study suggests that inflammatory factors in fluid drained from injury sites are promising tools for the prediction of SSI in the clinic.

Risk factors for surgical site infection after cesarean delivery in a rural area in China: A case–controlled study

“…If the level of CRP cannot return to normal after surgery and a postoperative fever occurred, the wound should be cared for. Studied from Iwata and BI reported similar findings [ 36 , 37 ].…”

Comprehensive analysis of risk factors for surgical site infections following thoracoscopic radical resection in patients with lung cancer

“…These inflammatory markers are part of the body's acute‐phase response to infection and can rapidly increase in bacterial infections. Their role as risk factors suggests that an aggressive management approach, possibly including earlier and more frequent monitoring, should be adopted when these markers are elevated 16 . Our study also emphasizes the protective role of perioperative antibiotic prophylaxis, with a p ‐value less than 0.05.…”

“…Their role as risk factors suggests that an aggressive management approach, possibly including earlier and more frequent monitoring, should be adopted when these markers are elevated. 16 Our study also emphasizes the protective role of perioperative antibiotic prophylaxis, with a p ‐value less than 0.05. This aspect of surgical care is pivotal in preventing SSIs.…”

Inhibition of USP14 suppresses ferroptosis and inflammation in LPS-induced goat mammary epithelial cells through ubiquitylating the IL-6 protein

“…IL-6 is rapidly produced in the process of internal trauma, surgery, stress response, infection, and other acute inflammatory reactions. The concentration of IL-6 in surgical patients can predict whether there will be surgical complications [15]. IL-6 also plays an important role in chronic inflammatory reactions, such as atherosclerosis and rheumatoid arthritis [16,17].…”