Serial interleukin 6 measurements in the early diagnosis of neonatal sepsis

Abstract

The objective of the present study was to evaluate serial interleukin 6 (IL6) levels in the early diagnosis of neonatal sepsis. Subjects included 255 neonates from the Neonatal Unit of Johannesburg Hospital evaluated for suspected sepsis between February and May 1998. All infants had IL6, full blood count (FBC), C reactive protein (CRP) and blood cultures done at presentation. CRP and IL6 were repeated after 24 h. Infants were categorized into groups according to the likelihood of infection on the basis of clinical presentation, CRP, FBC and culture results, i.e., group 1 (no infection) to group 4 (definite infection). IL6 was compared between the groups by the U-test of Mann-Whitney; stepwise logistic regression was done to establish the best predictors of infection, sensitivity, specificity, positive and negative predictive values were determined. The initial IL6 level was significantly raised in those infants with possible infection [880.67 pg/ml (2966.04), p value 0.0104], probable infection [422.62pg/ml (4077.7), p value 0.0021] and definite infection [11164.39pg/ml (24139.77), p value 0.0000] as compared to those infants without infection [58.65 (182.4)]. The best predictors of infection were the combination of the initial IL6 value and CRP value after 24 h (goodness of fit 97.7 per cent). An initial IL6 value below 20 pg/ml gave a negative predictive value of 90.18 per cent. It is concluded that an IL6 value done at the time of presentation of signs and symptoms suggestive of infection is useful in the early diagnosis of neonatal sepsis. In particular, an initial IL6 value below 20 pg/ml may allow antibiotics to be withheld in a number of infants evaluated for sepsis. There is no benefit in serial determination of IL6 in the diagnosis of neonatal sepsis.

A Quantitative Analysis of Ureaplasma urealyticum and Ureaplasma parvum Compared with Host Immune Response in Preterm Neonates at Risk of Developing Bronchopulmonary Dysplasia

“…These species were detected by culture-independent approaches in previous studies (17,18). These findings are also supported by data reported previously by Magudumana et al (14) and Beeton et al (2), who reported increases in levels of interleukin 6 (IL-6), the precursor to CRP production, in infants with infection compared to levels in infants without infection. The latter study also found a significant association between peak lung fluid IL-6 and interleukin-8 levels and the presence of microbes in newborn infants.…”

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

“…Beispielsweise wurden bei Fr ü hgeborenen bereits 1 -2 Tage vor der klinischen Diagnose der Sepsis erh ö hte IL-6-Konzentrationen nachgewiesen [60,61] . Die Bestimmung von IL-6 kann zudem zum Zeitpunkt erster infektions-verd ä chtiger Symptome die Fr ü hdiagnose einer neonatalen Sepsis erleichtern [62] .…”

Biomarkers in Pediatric Sepsis

“…It is produced by the liver in response to interleukin (IL)-6 generated during the inflammatory response to cellular injury. CRP is thought to assist in complement binding to foreign and damaged cells [8][9][10][11][12]. CRP is found to increase later in the course of sepsis than other biomarkers such as IL-6 and IL-1 [9].…”

“…CRP, when used in combination with IL-6, is a reliable marker of early infection and disease progression. IL-6 rises fast, but has a short half-life, so CRP is used to monitor disease after the 24-hour mark [11]. CRP rises over 2-3 days, peaking at 36-50 hours after the insult [13].…”

“…A volume of 2-3 milliliters of blood is required [18]. The assay is run by either nephelometry or immunoturbidity [11]. This involves combining CRP-containing serum with its specific CRP antibody to form antigen-antibody complexes that are insoluble.…”