Clinical impact of interleukin 6 as a predictive biomarker in the early diagnosis of postoperative systemic inflammatory response syndrome after major thoracic surgery: A prospective clinical trial

Fink-Neuboeck, Nicole; Lindenmann, Joerg; Bajric, Sedin; Maier, Andrea B.; Riedl, Regina; Weinberg, Annelie M.; Smolle‐Jüttner, Freyja‐Maria

doi:10.1016/j.surg.2016.04.004

Cited by 44 publications

(32 citation statements)

References 24 publications

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“…The numeric values (absolute levels) for each cytokine show high variability between the patients which is in accordance with the results in other studies on postoperative cytokine levels. [ 7 – 9 , 11 ] Due to the high interindividual variability and small sample size we aggregated the results for each cytokine at the time of wound closure and 24 hours after surgery into its quartiles ( S3 Table ). We sampled all patients who had cytokine levels below the first and above the third quartile.…”

Section: Resultsmentioning

confidence: 99%

“…[ 2 , 4 , 6 ] Non-cardiac thoracic surgery leads to a systemic release of pro- and anti-inflammatory cytokines especially on the day of surgery and first postoperative day. [ 7 – 9 ] Apart from the trauma caused by surgical incision, patients’ lungs experience ischemia/reperfusion injury due to one-lung ventilation. [ 10 ] As a consequence, macrophages in the alveoli secret a variety of cytokines.…”

Section: Introductionmentioning

confidence: 99%

“…[ 12 ] IL-6 was used as a predictive biomarker of systemic inflammatory response after non-cardiac thoracic surgery without analyzing a possible impact on postoperative complications. [ 7 ] To date, one study has focused on lung surgery comparing postoperative inflammation and outcome; IL-6 plasma concentrations of patients suffering from postoperative complications did not differ from those without complications. [ 13 ] As far as we know, there is no published data showing an early difference in the cytokine expression of lung surgery patients predicting postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications—A prospective, clinical study

et al. 2018

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BackgroundPostoperative complications after lung surgery are frequent, having a detrimental effect on patients’ further course. Complications may lead to an increased length of hospital stay and cause additional costs. Several risk factors have been identified but it is still difficult to predict contemporary which patients are at risk. We hypothesized that patients who show an increased inflammatory response at the time of wound closure and 24 hours after surgery are at risk of postoperative complications within 30 days after surgery.MethodsPostoperative complications (pulmonary, cardiac, neurological and renal) of 96 patients scheduled for lung surgery at the Medical Center–University of Freiburg were analyzed in this prospective, clinical study. Blood samples for cytokine analysis (Interleukin (IL)-6, IL-8, IL-10, Tumor necrosis factor [TNF]-α, IL-1ß and IL12p70) were taken before surgery, at wound closure and 24 hours after surgery. Cytokine levels of patients with and without postoperative complications were analyzed by Receiver operating characteristic (ROC) curve analysis. To adjust the results according to existing covariates a multivariate logistic regression analysis was conducted.ResultsThe complication and non-complication group differed significantly according to nicotine dependency, Angiotensin-receptor-II blocker medication, rate of thoracotomy and preoperative lung function. The intraoperative hemodynamic parameters and therapy did not differ between the groups. Twenty-nine patients (30%) developed postoperative complications within 30 days after surgery. Plasma concentrations of IL-6, IL-10 and IL-8 at the time of wound closure and 24 hours after surgery were higher in the complication group. Multivariate regression analysis on postoperative complications revealed an Odds ratio of 56 for patients with IL-6 and IL-8 levels above the 3rd quartile measured on the first postoperative day.ConclusionsPerioperative detection of increased plasma concentrations of inflammatory cytokines in lung surgery may be used in addition to other clinical predictors to identify patients at risk for postoperative complications.Trial registrationGerman Clinical Trials Register 00006961.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications—A prospective, clinical study

et al. 2018

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“…In this sense, low values as combined with the most viable biomarkers mentioned above may provide information about the aggressiveness of treatment necessary to save a patient's life well in advance of the most dangerous period. In essence, it helps differentiate “simple” sepsis (not insignificant in risk with upward of 20% mortality) from septic shock (over 60% mortality) ( 3 , 19 ).…”

Section: Soluble Triggering Receptor Expressed On Myeloid Cells-1 (Stmentioning

confidence: 99%

“…The combination of three sentinel biomarkers, IL-6, PCT, and sTREM-1, is uncommon, but pairs within the three have been attempted before to predict and/or prognosticate sepsis: sTREM-1 and PCT or sTREM-1 and IL-6 ( 3 , 24 , 37 ), while PCT is commonly used in a combination test itself. Recently, IL-6 and PCT together have been shown to predict patient outcome in non-classical cases of shock, that is, cardiogenic, indicating that these biomarkers may prove useful in sepsis of multiple types of etiologies when specific antibodies to bacterial endotoxin cannot be detected ( 40 ).…”

Section: What We Know: a Novel Set Of Biomarkers Proposed For The Earmentioning

confidence: 99%

A Novel Combination of Biomarkers to Herald the Onset of Sepsis Prior to the Manifestation of Symptoms

Dolin

Papadimos²,

Stepkowski³

et al. 2018

Shock

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Sepsis, which kills over 200,000 patients and costs over $20 billion in the United States alone, presents a constant but preventable challenge in the healthcare system. Among the more challenging problems that it presents is misdiagnosis due to conflation with other inflammatory processes, as its mechanisms are identical to those of other inflammatory states. Unfortunately, current biomarker tests can only assess the severity and mortality risk of each case, whereas no single test exists that can predict sepsis prior to the onset of symptoms for the purpose of pre-emptive care and monitoring. We propose that a single test utilizing three, rather than two, biomarkers that appear most quickly in the blood and are the most specific for sepsis rather than trauma, may improve diagnostic accuracy and lead to lessened patient morbidity and mortality. Such a test would vastly improve patient outcomes and quality of life, prevent complications for sepsis survivors, and prevent hospital readmissions, saving the American healthcare system money. This review summarizes the current use of sepsis biomarkers to prognosticate morbidity and mortality, and rejects the current single-biomarker and even combination biomarker tests as non-specific and inaccurate for current patient needs/pro-inflammatory cytokines, general markers of inflammation, and proteins specific to myeloid cells (and therefore to infection) are discussed. Ultimately, the review suggests a three-biomarker test of procalcitonin (PCT), interleukin-6 (IL-6), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) to diagnose sepsis before the onset of symptoms.

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Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults

Molano-Franco

Arévalo-Rodríguez

Figuls

et al. 2019

Cochrane Database of Systematic Reviews

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Clinical impact of interleukin 6 as a predictive biomarker in the early diagnosis of postoperative systemic inflammatory response syndrome after major thoracic surgery: A prospective clinical trial

Cited by 44 publications

References 24 publications

Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications—A prospective, clinical study

Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications—A prospective, clinical study

A Novel Combination of Biomarkers to Herald the Onset of Sepsis Prior to the Manifestation of Symptoms

Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults

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