Interleukin-6 as a diagnostic marker for infection in critically ill patients: A systematic review and meta-analysis - 07/08/18

Doi : 10.1016/j.ajem.2018.05.040

Shinya Iwase, MD ^a, Taka-aki Nakada, MD, PhD ^a,^{^⁎} , Noriyuki Hattori, MD, PhD ^a, Waka Takahashi, MD, PhD ^a, Nozomi Takahashi, MD ^a, Tuerxun Aizimu, MEng ^b, Masahiro Yoshida, MD, PhD ^c, Toshio Morizane, MD, PhD ^d, Shigeto Oda, MD, PhD ^a
^a Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan
^b Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
^c Department of Hemodialysis and Surgery, Chemotherapy Research Institute, Kaken Hospital, Chiba, Japan
^d Japan Council for Quality Health Care, Tokyo, Japan

^⁎Corresponding author at: Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan.Chiba University Graduate School of MedicineDepartment of Emergency and Critical Care Medicine1-8-1 InohanaChuoChiba260-8677Japan

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Abstract

Background

The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients.

Methods

We systematically searched the PubMed, MEDLINE, Cochrane Resister of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Igaku Chuo Zasshi databases for studies published from 1986 to August 2016 that evaluated the accuracy of IL-6 levels for the diagnosis of infection. We constructed 2 × 2 tables and calculated summary estimates of sensitivity and specificity using a bivariate random-effects model.

Results

The literature search identified 775 articles, six of which with a total of 527 patients were included according to the predefined criteria. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.73 (95% confidence interval [CI], 0.61–0.82), 0.76 (95% CI, 0.61–0.87), and 2.31 (95% CI, 1.20–3.48), respectively. The area under the curve (AUC) of the summary receiver operator characteristic (SROC) curve was 0.81 (95% CI, 0.78–0.85). In the secondary analysis of two studies with a total of 263 adult critically ill patients with organ dysfunction, the pooled sensitivity, specificity, and diagnostic odds ratio were 0.81 (95% CI, 0.75–0.86), 0.77 (95% CI, 0.67–0.84), and 2.87 (95% CI 2.15–3.60), respectively.

Conclusions

Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection.

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Keywords : Diagnosis, Biomarker, Critically ill patients, Sepsis, Septic shock, Organ dysfunction