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Eur J Pediatr Surg 2016; 26(02): 180-185
DOI: 10.1055/s-0034-1544047
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Serum Concentrations of Interleukin-6, Procalcitonin, and C-Reactive Protein: Discrimination of Septical Complications and Systemic Inflammatory Response Syndrome after Pediatric Surgery

Felix Neunhoeffer
1   Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Swantje Plinke
2   Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
,
Hanna Renk
1   Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Michael Hofbeck
1   Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Jörg Fuchs
3   Department Pediatric Surgery, University of Tübingen, Tübingen, Germany
,
Matthias Kumpf
1   Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Sabine Zundel
3   Department Pediatric Surgery, University of Tübingen, Tübingen, Germany
,
Guido Seitz
3   Department Pediatric Surgery, University of Tübingen, Tübingen, Germany
› Author Affiliations
Further Information

Publication History

05 August 2014

11 November 2014

Publication Date:
02 February 2015 (online)

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Abstract

Background Early differentiation between sepsis and systemic inflammatory response syndrome (SIRS) is useful for therapeutic management in neonates and infants after surgery.

Objective To compare the early (first 2 days) diagnostic value of interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) after surgery in the differentiation of subsequent SIRS and septic complications.

Methods IL-6, PCT, and CRP were measured 0, 24, and 48 hours after surgery in neonates and infants with clinical suspicion of postoperative sepsis. Sensitivity, specificity, and predictive values for SIRS/septic complications were calculated.

Results A total of 31 out of 205 neonates and infants showed clinical signs for postoperative sepsis and underwent sepsis work-up. Nine patients developed septic complications, sixteen patients met criteria for SIRS, and six patients showed an uneventful postoperative course during the first five postoperative days. IL-6, PCT, and CRP levels increased in all subgroups after surgery and were significantly higher in the sepsis group (p < 0.05). IL-6 peaked immediately, CRP at 24 to 48 hours, and PCT at 24 hours after surgery. Sensitivity and specificity (area under the curve) for IL-6 (cutoff 673 ng/dL) were 94.4 and 75% (86.2%), for CRP (cutoff 1.48 mg/dL) 76.2 and 75.0% (88.1%), and for PCT (cutoff 16.1 mg/L) 66.7 and 57.1% (65.6%).

Conclusion IL-6 appears to be an early marker for severe bacterial infections with high sensitivity. IL-6 and CRP were the most reliable markers for the discrimination between SIRS and sepsis within the postoperative period.

Keywords

interleukin-6 - procalcitonin - surgery - SIRS - sepsis
 

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