C-Reactive Protein and Interleukin-6 Levels in the Early Detection of Infection after Open Fractures

Abstract

purpose. To measure C-reactive protein (CRP) and interleukin-6 (IL-6) levels in 30 patients with open fractures and correlate the levels with infection. Methods. 29 men and one woman aged 9 to 70 (mean, 37) years presented with open fractures of the upper or lower extremity within 12 hours of injury and underwent debridement and external fixation 3 to 40 (mean, 16) hours after injury. Serum CRP and IL-6 concentrations were measured preoperatively and on postoperative days 2 and 4. CRP was measured using latex agglutination and nephelometry, and IL-6 by enzyme-linked immunosorbent assay. The mean CRP and IL-6 levels in infected and non-infected patients were compared. The trend of CRP and IL-6 levels within the infected group was analysed. Correlations between CRP and infection, and between IL-6 and infection were analysed. results. 11 of the 30 patients developed wound infection. The day-2 CRP levels of 30 patients were positive (range, 7-28 µg/ml). In 27 patients, the CRP C-reactive protein and interleukin-6 levels in the early detection of infection after open fractures levels were higher on day 2 than preoperation. On day 4, CRP levels declined sharply in patients without infection (mean, 8 µg/ml) but were persistently elevated in patients with infection (mean, 17 μg/ml). The sensitivity and specificity of the CRP test were 100% and 42%, respectively. In the 11 patients with infection, the IL-6 concentrations were elevated at day 2 (mean, 689 pg/ml) and decreased progressively at day 4 (mean, 175 pg/ml). The sensitivity and specificity of the IL-6 test were 90% and 100%, respectively. Infection correlated with CRP and IL-6 levels. conclusions. Serial serum measurements of IL-6 and CRP levels help in the early diagnosis of infections after open fractures before they are clinically evident.

Early Modification in Drainage of Interleukin-1β and Tumor Necrosis Factor-α Best Predicts Surgical-Site Infection After Cervical Neck Dissection for Oral Cancer

“…Similarly, it has been reported that persistently high levels of IL-6 at day +3 after an open fracture are indicative of infection at the fracture site. 35 In the present study, patients without SSI showed a downward trend in IL-6 levels from day +1 to day +3, reflecting the natural evolution of this cytokine after surgery, whereas patients with SSI showed persistently high levels (Fig 1). The usefulness of wound exudate IL-6 levels as a normal healing marker has been recently reported, with levels returning to normal after targeted therapies.…”

Preoperative Diagnosis of Infection in Patients with Nonunions

“…Also, newer inflammatory markers such as interleukin-6 (IL-6) were not investigated as they were not available at our institution. The literature has shown IL-6 to be an effective indicator of postoperative infection because it increases more rapidly and returns to normal more quickly than do the CRP level and ESR 15,16 . IL-6 may be a useful marker to add to the protocol for future investigation.…”

Surgical management of infected non-unions: An update

“…In the attempt to identify further independent predictors of infection in patients with non-unions, researchers have focused between others (transforming growth factor-b, alkaline phosphatase, osteocalcin [33]) to the IL6 molecule (interleukin-6) [34][35][36]. It appears that its levels increase more rapidly and return to normal also faster than the CRP, however remains still outside the routine clinical toolbox [37][38][39].…”