High IL-6 after abdominal surgery an ominous sign

Reuters Health Information: High IL-6 after abdominal surgery an ominous sign

High IL-6 after abdominal surgery an ominous sign

Last Updated: 2015-07-23

By Reuters Staff

NEW YORK (Reuters Health) - High interleukin-6 (IL-6) levels on the first day after abdominal surgery may identify patients at increased risk for complications in the ensuing days, a new study hints.

The study shows that levels of IL-6 help distinguish patients at low and high risk for complications following abdominal surgery before changes in C-reactive protein (CRP) levels, the authors say.

Major abdominal surgery is common, as are postoperative complications, and systemic inflammation following surgery may be partly to blame, Dr. Peter Noordzij and colleagues from St. Antonius Hospital, Nieuwegein, the Netherlands, note in their Annals of Surgery online report.

They assessed C-reactive protein (CRP), IL-6, and tumor necrosis factor-alpha (TNF-alpha) and the systemic inflammatory response syndrome (SIRS) in 137 patients having major abdominal surgery. They took blood samples right before surgery, and on days one, three and seven afterward and checked for SIRS during 48 hours after surgery.

The primary outcome was a composite of mortality, pneumonia, sepsis, anastomotic dehiscence, wound infection, noncardiac respiratory failure, atrial fibrillation, congestive heart failure, myocardial infarction, and reoperation happening within 30 days of surgery.

According to the researchers, patients with an IL-6 level higher than 432 pg/mL on the first postoperative day were more likely to suffer complications (adjusted odds ratio 3.3) and stay longer in the hospital (median 12 vs 7 days, P<0.001).

"As a single test, an IL-6 cut-off level of 432 pg/mL on day 1 yielded a specificity of 70% and a sensitivity of 64% for the prediction of complications," the researchers report. "Levels of CRP started to discriminate from day 3 onward with a specificity of 87% and a sensitivity of 58% for a cut-off level of 203 mg/L."

Because the diagnostic accuracy of IL-6 on day 1 for predicting postoperative complications is similar to the accuracy of CRP on day 3, IL-6 levels "can have added value in early clinical decision-making," they conclude.

A companion paper in Annals of Surgery reports the diagnostic accuracy of CRP and procalcitonin as early predictors of infection after elective colorectal surgery with anastomosis in 501 patients. Dr. Olivier Facy, from University Hospital, Dijon, France, and colleagues measured CRP and procalcitonin daily until the fourth postoperative day.

An intra-abdominal infection occurred in 59 patients (11.8%), wound infection in 48 (9.7%), urinary tract infection in 24 (4.8%), pneumonia in six (1.2%) and catheter-related infection in nine (1.8%). Overall, 123 patients (24.6%) had at least one infectious complication.

On day four after surgery, CRP was "more discriminating" than procalcitonin for detecting intra-abdominal infection (p=0.03) and all infectious complications (p=0.0002), suggesting that CRP "should be systematically measured at the fourth postoperative day," the authors conclude. In their view, "It is a useful tool to ensure a safe early discharge after elective colorectal surgery."

Neither study had commercial funding and the authors have no relevant disclosures. They were unavailable for comment by press time.

SOURCE: http://bit.ly/1JAjTRN and http://bit.ly/1VzJNOT

Ann Surg 2015.

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