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Crit Care Med. 1993 Aug;21(8):1175-80.

Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients: diagnostic signs in nosocomial infection.

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  • 1Department of Anaesthesia, University Hospital, Basel, Switzerland.

Abstract

OBJECTIVE:

To determine the value of serum concentrations of interleukin-6 (IL-6), C-reactive protein, and glycosylation of alpha 1-acid glycoprotein as tools for diagnosing nosocomial infection in surgical intensive care unit (ICU) patients.

DESIGN:

Prospective, consecutive entry study of patients with an anticipated stay of at least 24 hrs in a surgical ICU.

SETTING:

University hospital, a major provider of acute surgical care.

PATIENTS:

One hundred four consecutive patients admitted to the surgical ICU between March and June 1990.

MEASUREMENTS:

Concentrations of IL-6, C-reactive protein, and glycosylation of alpha 1-acid glycoprotein were measured on days 1 and 6 after ICU admission. Clinical evaluation for infection was performed daily in a blinded fashion, i.e., without knowing the results of the acute-phase parameters.

MAIN RESULTS:

On day 6 after surgery or trauma, nosocomial infection could be ascertained in 13 cases. The clinical parameter of fever > 38 degrees C had a sensitivity of 54% and a specificity of 90% to demonstrate nosocomial infection. Infected patients showed increased concentrations of IL-6 (p < .001), C-reactive protein (p < .001), and increased reactivity of alpha 1-acid glycoprotein to concanavalin A (p < .001) compared with patients without infections. By choosing appropriate cutoff values, IL-6 determinations had the highest specificity (97%), and C-reactive protein values had the highest sensitivity (85%) for diagnosing nosocomial infections. In uninfected patients, 81% of the IL-6 values, but only 29% of the C-reactive protein values, were back to the normal range on day 6 after injury.

CONCLUSION:

Due to the rapid normalization after trauma, a single measurement of the serum IL-6 concentration may be useful to support or refute the clinical suspicion of nosocomial infection.

PMID:
8339583
[PubMed - indexed for MEDLINE]
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