Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis

Jain, Saransh; Midha, Shallu; Mahapatra, Soumya Jagannath; Gupta, Sanchita; Sharma, Manish Kumar; Nayak, Baibaswata; Jacob, Tony George; Shalimar, S.; Garg, Pramod Kumar

doi:10.1016/j.pan.2018.05.002

Cited by 32 publications

(24 citation statements)

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“…At present, sepsis, septic shock and multiple organ dysfunction syndromes are considered to be the dynamic process of pathophysiological changes and clinical severity changes of severe pancreatitis [19,20]. The essence is that the body's systemic inflammatory response continues to intensify and worsen, and the balance between the metabolic anti-inflammatory responses is destroyed, which is one of the main causes of the occurrence and death of the severe acute pancreas [21,22]. Neopterin can promote the synthesis and participates in the pathological process of inflammatory reaction [23].…”

Section: Discussionmentioning

confidence: 99%

Changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis

Zhang

Wang

Ji³

et al. 2020

Journal of Laboratory Medicine

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ObjectivesTo investigate the dynamic changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis.Methods54 cases with confirmed diagnosis of acute pancreatitis were included in the present work. Of the included 54 cases, 21 were mild acute pancreatitis and other 33 were server diseases. For the 33 severe cases, nine were finally dead and 24 were survived. The serological neopterin level of the 54 acute pancreatitis was continuously examined at the time point of days 0 (diagnosis), 1 (24 h after diagnosis), 2, 4, 8 and 14 by the enzyme linked immunosorbent assay (ELISA). The severity or death risk of the acute pancreatitis patients was predicted by the serological neopterin.ResultsThe serological neopterin was gradually increasing from days 0 to 8, but descending at day 14 in mild and survival groups. For days 8 and 14, the serological levels of neopterin in severe group were higher than those of mild group with statistical difference (p<0.05). The serum neopterin was statistical different in the time point of day 8 and day 14 between death and survival groups (p<0.05). For day 8, the serological neopterin as biomarker for death prediction sensitivity and specificity were 88.89% (95% CI: 51.75–99.72%) and 83.33% (95% CI: 62.62–95.26%) respectively with the AUC of 0.95 (95% CI: 0.88–1.00). For day 14, the death prediction sensitivity and specificity were 77.78% (33.99–97.19%) and 95.83% (78.88–99.89%) respectively with the AUC of 0.94 (95%CI:0.87–1.00).ConclusionsSerological neopterin level was elevated with the development of the pancreatitis. Continuously monitoring the serum neopterin may helpful for prediction death risk of acute pancreatitis. In the later phase of disease beginning on day 8, neopterin levels may be used for risk assessment and possibly change of therapy regiment.

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Section: Discussionmentioning

confidence: 99%

Changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis

Zhang

Wang

Ji³

et al. 2020

Journal of Laboratory Medicine

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“…Only the BALI score proposed in 2006 by Spritzer et al [ 31 ] utilized cytokine (IL-6) measurement as a component of prognostic assessment. Very recently, it has been shown that the addition of IL-6 improves the prediction of SAP based on SIRS criteria [ 29 ]. Nonetheless, because of the limited availability of routine IL-6 tests, BALI prognostic score has been rarely implemented.…”

Section: Discussionmentioning

confidence: 99%

“…In mild AP, the inflammation remains restricted to the pancreas, while moderately severe and severe cases are associated with systemic activation of immune cells, including lymphocytes, neutrophils, and monocyte/macrophage lineage, associated with an increased expression of IL-6, IL-8, macrophage migration inhibitory factor, myeloperoxidase, neutrophil elastase, or leukotriene B4 [ 35 ]. The recent study of Jain et al [ 29 ] points towards genetic polymorphism of the IL-6 gene (−174 G/C polymorphism) as a cause of higher serum concentrations of IL-6, among patients with more severe AP. However, the decrease in lymphocyte counts is observed in SAP simultaneously with SIRS, as well as in the increase in serum levels of anti-inflammatory cytokines, including IL-10 [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Does the Automatic Measurement of Interleukin 6 Allow for Prediction of Complications during the First 48 h of Acute Pancreatitis?

Kolber¹,

Dumnicka

Maraj

et al. 2018

IJMS

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Acute pancreatitis (AP) in most patients takes a course of self-limiting local inflammation. However, up to 20% of patients develop severe AP (SAP), associated with systemic inflammation and/or pancreatic necrosis. Early prediction of SAP allows for the appropriate intensive treatment of severe cases, which reduces mortality. Serum interleukin-6 (IL-6) has been proposed as a biomarker to assist early diagnosis of SAP, however, most data come from studies utilizing IL-6 measurements with ELISA. Our aim was to verify the diagnostic usefulness of IL-6 for the prediction of SAP, organ failure, and need for intensive care in the course of AP using a fully automated assay. The study included 95 adult patients with AP of various severity (29 mild, 58 moderately-severe, 8 severe) admitted to a hospital within 24 h from the onset of symptoms. Serum IL-6 was measured using electochemiluminescence immunoassay in samples collected on admission and on the next day of hospital stay. On both days, patients with SAP presented the highest IL-6 levels. IL-6 correlated positively with other inflammatory markers (white blood cell and neutrophil counts, C-reactive protein, procalcitonin), the markers of renal injury (kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin), and the markers of endothelial dysfunction (angiopoietin-2, soluble fms-like tyrosine kinase-1). IL-6 on admission significantly predicted SAP, vital organ failure, and the need for intensive care or death, with areas under the receiver operating curve between 0.75 and 0.78, not significantly different from multi-variable prognostic scores. The fully automated assay allows for fast and repeatable measurements of serum IL-6, enabling wider clinical use of this valuable biomarker.

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“…In contrast to PCT and CRP, the predictive capacity of IL-6 has been studied in diverse intensive care contexts, showing overall good performances regarding prediction of mortality or other adverse outcomes [24][25][26][27][28][29][30][31][32][33][34][35][36]. Thus, IL-6 seems to be a rather reliable marker of illness severity and mortality in association with acute inflammatory responses [49].…”

Section: Plos Onementioning

confidence: 99%

Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP

et al. 2020

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We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality. Material and methods This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill patients that were admitted to the internal medicine department. To evaluate discrimination performance, the area under the receiver operating characteristic curves (AUROCs) and the 95% confidence intervals (95% CIs) were calculated for each score, exclusively or in combination with IL-6 or PCT or CRP. DeLong test was used to compare different AUROCs. Results The SAPS 2 exhibited a better discrimination performance than SAPS 3 with AUROCs of 0.81 (95% CI, 0.76-0.86) and 0.72 (95% CI, 0.66-0.78), respectively. Overall, combination of the SAPS 2 with IL-6 showed the best discrimination performance (AUROC 0.82; 95% CI, 0.77-0.87), albeit not significantly different from SAPS2. IL-6 performed better than PCT and CRP with AUROCs of 0.75 (95% CI, 0.69-0.81), 0.72 (95% CI, 0.66-0.77) and 0.65 (95% CI, 0.59-0.72), respectively. Performance of the SAPS 3 improved significantly when combined with IL-6 (AUROC 0.76; 95% CI, 0.69-0.81) or PCT (AUROC 0.73; 95% CI, 0.67-0.78). Conclusions Our analysis provided evidence that the risk stratification performance of the SAPS 3 and, to a lesser degree, also of the SAPS 2 can increase when combined with IL-6. A more

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Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis

Cited by 32 publications

References 39 publications

Changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis

Changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis

Does the Automatic Measurement of Interleukin 6 Allow for Prediction of Complications during the First 48 h of Acute Pancreatitis?

Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP

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