Vaginal fluid interleukin-6 concentrations as a point-of-care test is of value in women with preterm prelabor rupture of membranes

Musilová, Ivana; Bestvina, Tomas; Hudeckova, Martina; Michalec, Igor; Cobo, Teresa; Jacobsson, Bo; Kacerovský, Marian

doi:10.1016/j.ajog.2016.07.001

Cited by 53 publications

(35 citation statements)

References 37 publications

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“…The study also identified a 1000 pg/mL cutoff in PROM patients for identifying histological chorioamnionitis in combination with microbial amniotic invasion (sensitivity 60%, specificity 94%). However, amniocentesis is extremely invasive, prompting Musilova et al (2016) to test cytokine levels in vaginal fluid of pregnant women in an attempt to predict preterm PROM-related inflammation in a less invasive manner [56]. IL-6 was determined to be associated with microbial invasion of the amniotic cavity, as well as intra-amniotic inflammation and microbial-associated intra-amniotic inflammation, and was able to predict these conditions at a cutoff of 2500 pg/mL with high sensitivity and specificity: 53% and 89%, 74% and 91%, and 100% and 90%, respectively.…”

Section: Role Of Cytokines and Their Clinical Cutoffs In Obstetricmentioning

confidence: 99%

Cytokines as Biomarkers and Their Respective Clinical Cutoff Levels

Monastero

Pentyala

2017

International Journal of Inflammation

172

129

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Cytokines, including interleukins, interferons, tumor necrosis factors, and chemokines, have a variety of pro- and anti-inflammatory effects in the body through a number of biochemical pathways and interactions. Stimuli, actions, interactions, and downstream effects of cytokines have been investigated in more depth in recent years, and clinical research has also been conducted to implicate cytokines in causal patterns in certain diseases. However, particular cutoffs of cytokines as biomarkers for disease processes have not been well studied, and this warrants future work to potentially improve diagnoses for diseases with inflammatory markers. A limited number of studies in this area are reviewed, considering diseases correlated with abnormal cytokine profiles, as well as specific cutoffs at which cytokines have been deemed clinically useful for diagnosing those diseases through Receiver Operator Characteristics modeling. In light of studies such as those discussed in this review, cytokine testing has the potential to support diagnosis due to its lack of invasiveness and low cost, compared to other common types of testing for infections and inflammatory diseases.

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Section: Role Of Cytokines and Their Clinical Cutoffs In Obstetricmentioning

confidence: 99%

Cytokines as Biomarkers and Their Respective Clinical Cutoff Levels

Monastero

Pentyala

2017

International Journal of Inflammation

172

129

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“…Recently, a device was developed for the retrieval of AF in patients with preterm PROM [65]. The assay of such fluid for inflammatory markers may help in the identification of patients with true intra-amniotic inflammation [109–111]. In patients with preterm labor with intact membranes or acute cervical insufficiency, examination of AF retrieved by amniocentesis is probably the best method to assess the true state of the amniotic cavity.…”

Section: Research Implicationsmentioning

confidence: 99%

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Kim

Hong

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Recent studies on clinical chorioamnionitis at term suggest that some patients with this diagnosis have neither intra-amniotic infection nor intra-amniotic inflammation. A false-positive diagnosis of clinical chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. Objective To determine the frequency of intra-amniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical chorioamnionitis. Study design Amniocentesis was performed in singleton pregnant women with preterm clinical chorioamnionitis (<36 weeks of gestation). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 concentration. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture; intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration of >23 ng/mL. Non-parametric and survival techniques were used for analysis. Results Among patients with preterm clinical chorioamnionitis, 24% (12/50) had microbiologic evidence of neither intra-amniotic infection nor intra-amniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intra-amniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intra-amniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. Conclusion Among patients with preterm clinical chorioamnionitis, 24% had no evidence of either intra-amniotic infection or intra-amniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a re-examination of the criteria used to diagnose preterm clinical chorioamnionitis.

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“…Therefore, this type of test is important from a clinical point of view, since the entire procedure of sampling followed by a rapid evaluation of IL-6 in a fresh sample can be performed directly in a Labor and Delivery ward. Recently, the pointof-care vaginal fluid IL-6 value of 2,500 pg/mL has been suggested to be the cut-off value for the identification of MIAC and intra-amniotic inflammation in women with PPROM [15]. However, there is a paucity of information whether this cut-off value is efficient and reliable in PPROM between 34 and 37 weeks.…”

Section: Introductionmentioning

confidence: 92%

“…In case of clinical doubt, amniotic fluid leaking was confirmed by the presence of insulin-like growth factor-binding proteins (ACTIM PROM test; MedixBiochemica, Kauniainen, Finland) in the vaginal fluid [17]. This cohort of women was different from the cohort of women used in our previous paper about pointof-care vaginal fluid IL-6 concentrations [15].…”

Section: Patient Populationmentioning

confidence: 99%

“…Moreover, this point-of-care alternative might serve as a noninvasive test of intra-amniotic environment in women with PPROM [15,16]. Therefore, this type of test is important from a clinical point of view, since the entire procedure of sampling followed by a rapid evaluation of IL-6 in a fresh sample can be performed directly in a Labor and Delivery ward.…”

Section: Introductionmentioning

confidence: 99%

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Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Point-of-Care Test of Vaginal Fluid Interleukin-6 Concentrations for a Noninvasive Detection of Intra-Amniotic Inflammation

et al. 2017

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Objective: The aim of this study was to investigate whether a previously reported vaginal fluid point-of-care interleukin (IL)-6 cut-off value of 2,500 pg/mL can be used for the identification intra-amniotic inflammation in women with preterm prelabor rupture of membranes (PPROM) between 34 and 37 weeks. Material and Methods: A prospective cohort study was conducted in women with singleton gestation complicated by PPROM between 34 + 0 and 36 + 6 weeks.Vaginal fluid was successfully obtained in 118 women from the posterior vaginal fornix via aspiration using a sterile urine sample tube with a suction tip. Amniotic fluid was obtained via transabdominal amniocentesis. IL-6 concentrations were assessed in both fluids immediately after sampling. Intra-amniotic inflammation was defined as an amniotic fluid point-of-care IL-6 concentration of ≥745 pg/mL. Results: The tested vaginal fluid IL-6 cut-off value had a sensitivity of 91%, specificity of 91%, positive predictive value of 50%, negative predictive value of 99%, positive likelihood ratio of 9.7, and negative likelihood ratio of 0.1 for the identification of intra-amniotic inflammation. Conclusion: The point-of-care vaginal fluid IL-6 test with a cut-off value of 2,500 pg/mL shows good sensitivity, specificity, and negative predictive value for the identification of intra-amniotic inflammation in PPROM between 34 and 37 weeks.

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Vaginal fluid interleukin-6 concentrations as a point-of-care test is of value in women with preterm prelabor rupture of membranes

Cited by 53 publications

References 37 publications

Cytokines as Biomarkers and Their Respective Clinical Cutoff Levels

Cytokines as Biomarkers and Their Respective Clinical Cutoff Levels

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Point-of-Care Test of Vaginal Fluid Interleukin-6 Concentrations for a Noninvasive Detection of Intra-Amniotic Inflammation

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