Maternal Serum Interleukin-6: A Non-Invasive Predictor of Histological Chorioamnionitis in Women with Preterm-Prelabor Rupture of Membranes

Abstract

Objective: To assess the added value of maternal serum levels of IL-6 in women with preterm-prelabor rupture of membranes (PPROM) as a non-invasive test for the prediction of histological chorioamnionitis (HCA). Methods: This was a prospective cohort study of pregnant women between 20 + 0 and 36 + 6 weeks of gestation with a confirmed diagnosis of PPROM. Logistic regression models were created for the prediction of HCA and compared by assessing the improvement in their Naegelkerke R² as a measure of goodness of fit. Predictive performance of all models was assessed by receiver operating characteristics curve (ROC) analysis and compared by the DeLong method. Results: From 47 women with PPROM, 31 (66%) developed HCA. Maternal serum IL-6 ≥19.5 pg/dL was the best cut-off point for the prediction of HCA (OR = 15; 95% CI: 3.6–61; p < 0.01). A model comprising maternal characteristics and IL-6 ≥19.5 pg/dL showed an area under the curve of 0.85 (95% CI: 0.74–0.95), significantly improving the previous models of IL-6 ≥19.5 pg/dL (R²: 23.3 vs. 34.1%; p = 0.01) or maternal characteristics (R²: 8.4 vs. 34.1%; p < 0.01). Conclusions: A model comprising maternal serum levels of IL-6 plus maternal characteristics proves to be a good non-invasive predictor of HCA.

Maternal serum IL-22 concentrations are significantly upregulated in patients with preterm premature rupture of membranes

“…We collected the blood samples to measure IL-22 levels at the time of the hospitalization. We also took maternal blood samples to analyze complete blood count (CBC) every 72 hours, evaluating clinical chorioamnionitis every eight hours after hospitalization and during the latency period [11]. All pregnant women with PPROM underwent ampicillin treatment daily to prevent chorioamnionitis and four doses of 6 mg of betamethasone for fetal lung maturation.…”

“…Histological chorioamnionitis (HCA) being reported in about 40-70% of PPROM patients [10]. Immediate and correct HCA diagnosis is essential; however, the event restricts that placental pathology can only be assessed after delivery [11]. The inflammatory response can also be shown in the amniotic fluid and maternal and fetal serum.…”

Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes

“…Another model comprising maternal serum levels of IL‐6 associated with maternal characteristics proved to be a good non‐invasive predictor infection in pregnancies complicated with P‐PROM . Several maternal serum markers were studied for the prediction of histological chorioamnionitis (HCA) after P‐PROM.…”

“…48 Another model comprising maternal serum levels of IL-6 associated with maternal characteristics proved to be a good non-invasive predictor infection in pregnancies complicated with P-PROM. 49 Several maternal serum markers were studied for the prediction of histological chorioamnionitis (HCA) after P-PROM. A blood sample was obtained before delivery and analyzed for CRP, intercellular adhesion molecule-1, IL-6, IL-8, matrix-metalloproteinase (MMP) 8 and 9, triggering receptor on myeloid cells, and human neutrophile peptides.…”

Interleukin‐6 pathobiology in equine placental infection

“…An inflammatory modulating cytokine, IL‐6 remains a primary target for prediction of ascending infection during pregnancy in a variety of species 12,14‐16,19,20 . IL‐6 concentration increases in human amniotic fluid, 12,15,21 vaginal fluid, 22,23 cervical fluid, 24‐26 maternal circulation, 27,28 and in fetal and maternal tissues 29,30 following feto‐placental infection, although amniotic fluid remains the most sensitive and specific predictor of placental infection. IL‐6 is able to function as both pro‐ and anti‐inflammatory due to its ability to activate varying receptors (soluble and transmembrane) and different pathways (JAK/STAT, Ras, NFkβ) 31 .…”