Serum Concentrations of Interleukin-6, Procalcitonin, and C-Reactive Protein: Discrimination of Septical Complications and Systemic Inflammatory Response Syndrome after Pediatric Surgery

Abstract

IL-6 appears to be an early marker for severe bacterial infections with high sensitivity. IL-6 and CRP were the most reliable markers for the discrimination between SIRS and sepsis within the postoperative period.

Development and validation of a diagnostic model for early differentiation of sepsis and non-infectious SIRS in critically ill children - a data-driven approach using machine-learning algorithms

“…A combination of 8 out of more than 40 clinical and laboratory parameters was identified as relevant predictors. Some of the identified variables like PCT, CRP and IL-6 have been proposed before as markers for the differentiation between non-infectious SIRS and sepsis [ 9 , 11 ]; others have not yet been described. These comprise laboratory parameters like platelet count and indicators of disease severity like presence of a central venous line or core temperature.…”

“…By combining our purely data-driven approach with rigorously performed validation techniques, we were able to provide a realistic view on the maximum diagnostic accuracy for differentiation of pediatric non-infectious SIRS and sepsis associated with routinely available information. Several previous studies barely mentioned validation processes, so that overfitting and thus overestimation of model performance is very likely [ 11 , 14 ]. If we did not incorporate validation techniques in our analysis, we got an AUC of 0.98 resulting in an almost perfect discrimination between SIRS and sepsis.…”

“…In the past decades, several biomarkers have been proposed as diagnostic tests for the differentiation of sepsis and non-infectious SIRS [ 7 , 8 ], like e.g. procalcitonin (PCT) and interleukin-6 (IL-6) [ 9 – 11 ]. However, none of them was considered suitable to diagnose sepsis with sufficient accuracy in clinical practice [ 12 ].…”

“…However, none of them was considered suitable to diagnose sepsis with sufficient accuracy in clinical practice [ 12 ]. In some cases, initial study results were overoptimistic due to flawed study designs and lack of external validation [ 10 , 11 ]; in others, the proposed markers were too expensive or too difficult to obtain for being implemented in the therapeutic standards of intensive care medicine [ 13 ]. In an adult population, a recent study showed that the discriminatory ability of several weak sepsis biomarkers could be improved when combining them into one diagnostic model [ 14 ].…”

Value of evaluating procalcitonin kinetics in diagnosis of infections in patients undergoing laparoscopic radical cystectomy

“…Considering that the timing of clinical diagnosis of postoperative infections is quite different, this complex retrospective analysis of all results is totally different from “defining” patients as infectious, with the same schedule after the surgery as seen in several studies. [ 38 , 39 ] Because infectious complications did not occur at the same time, in this study we provided a more robust approach utilizing all clinical data available trying to identify the fastest and most reliable biomarker to aid in the diagnosis of postsurgery infection.…”