The Significance Of IL-6 In The Early Detection Of Surgical Site Infections In Gastrointestinal Fistulae

Background: The intestinal fistulae surgery is one of the most complicated operations.This kinds of surgery are almost contaminated with digestive juice.And its has high risk developing the surgical site infections(SSIs).Serum inflammatory markers including white blood cell count(WBC),C-reactive protein(CRP),interleukin 6(IL-6),and procalcitonin(PCT)have been used for diagnosis of postoperative complication.The present study was to assess the value of inflammatory markers in predicting SSIs after intestinal fistulae resection.The kinetic of IL-6 PCT CRP were assessed in patients with intro-abdominal infections,and then analyzing the prognostic value of there biomarkers in these patients.Methods: 1.We prospectively enrolled a total of 184 consecutive patients who underwent elective gastrointestinal reconstruction for fistulae without existing clinical infection.Plasma IL-6 levels,serum PCT,CRP concentration and WBC were assessed preoperatively and on postoperative days(PODs)1,3 and 7.The predictive value of each laboratory marker for SSIs was calculated.2.92 patients were enrolled in this study from December 2015 to January 2017 in Jin Ling Hospital.All the patients were immediately given the broad-spectrum antibiotic and source control.The patients were divided into effective and ineffective groups after 7 days of treatment.Serm IL-6,PCT,and CRP were detected on the time of admission and after 1,3,5,7 days.Three biomarkers clearance rate were also calculated to determind the value in juding therapeutic intervention.ROC was utilized to evaluate the prognostic value of three biomarkers and its clearance rate.Results: 1.The occurrence rate of SSIs after definitive operation for gastrointestinal fistulae was 26.6%.IL-6,PCT and CRP levels were significantly higher in SSIs patients than patients without SSIs on POD 1,POD 3.IL-6: 163.8(112.6–352.2)ng/L versus 84.2(50.4–173.7)ng/L(P < 0.01)on day 1;71.1(34.9–151.1)ng/L versus 38.8(24.6–64.8)ng/L,(P <0.01)on day 3;PCT: 1.51(0.72–3.14)ug/L versus 0.85(0.31–1.67)ug/L(P=0.026)on day 1;0.94(0.40–2.59)ug/L versus 0.42(0.18–0.81)pg/L,(P <0.01)on day 3.C-reactive protein(CRP): 63.2(40.8–102.9)mg/L versus 48.4(27.9–82.5)mg/L(P =0.037)on day 1;167.7(125.2–203.3)mg/L versus 120.7(79.8–165.4)mg/L,(P=0.012)on day 3.whereas there was no statistical significance for WBC counts between two groups.By ROC curve analysis for inflammatory markers on POD 1,POD 3,IL-6 and PCT had relatively higher diagnostic effectiveness in predicting development of SSIs.The AUC of IL-6 is 0.77 and 0.70 on POD 1 and POD 3 with a sensitivity of 85.7% and specificity of 63.9%,a sensitivity of 67.4% and specificity of 68.6%,respectively.2.A total of 92 patients were recruited,62(67.4%)in effective group,30(23.6%)in ineffective group afer 7 days of anti-infection therapy.IL-6 was significantly declined in effective group on d1.The median between effective group and ineffective group were(50.3ng/L:92.5ng/L,p<0.01).PCT and CRP were significantly declined on d3,On the third day PCTd3 and CRPd3 median between effective group and ineffective are PCTd3(0.24ug/L,1.22ug/L,p<0.01),CRPd3(57.4mg/L,118.8mg/L,p<0.01).In the ineffective group both PCT and CRP were increased on d1 and d3.IL-6c5?PCTc3?PCTc5?CRPc3?CRPc5 were siginifcantly higher in effective group than inffecive group(p<0.05).The AUC of PCTc3,PCTc5,CRPc3 and CRPc5 were 0.687,0.686,0.658,0.672 and 0.697.On the third day after treatment,PCTc had higher diagnostic efficacy,followed by CRP.On the fifth day after treatment,CRP had higher diagnostic efficacy,followed by IL-6.Conclusion: The levels of IL-6 above 95.6 ng/L on POD 1 and 52.5ng/L on POD 3,and the concentration of PCT exceed 0.61ug/L could predict the occurrence of SSIs after definitive operations for gastrointestinal fistulae.The level of Il-6 began to decline significantly after the first day of treatment,and the PCT and CRP levels began to decline significantly in the third day after the efficacy of anti-infection treatment.On the third day after anti-infection treatment,Il-6 was able to predict therapeutic effects.The efficacy of il-6 was the strongest in the 5th day of anti-infection treatment,followed by PCT and CRP.