Zhang Dongming, Ren Jianan, Arafeh Mohamed-Omar, Sawyer Robert G, Hu Qiongyuan, Wu Xiuwen, Wang Gefei, Gu Guosheng, Hu Jiang, Li Mingzhang
1 Jinling College, Nanjing Medical University , Nanjing, China .
2 Department of General Surgery, Jinling Hospital, Medical School of Nanjing University , Nanjing, China .
Surg Infect (Larchmt). 2018 Jul;19(5):523-528. doi: 10.1089/sur.2017.271. Epub 2018 May 23.
Surgical site infections (SSIs) are among the most common complications after definitive treatment for intestinal fistulae. Serum inflammatory markers including white blood cell count (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), as well as procalcitonin (PCT) have been used to help diagnosis post-operative complications.
The goal of this study was to assess the clinical value of inflammatory markers, specifically IL-6, in predicting SSIs after intestinal fistulae resection.
A total of 184 consecutive patients who underwent elective intestinal fistula resection were enrolled prospectively. All patients were screened to exclude patients with existing clinical infection. Plasma IL-6 concentrations, serum PCT, and CRP concentrations were measured pre-operatively and on post-operative days one, three, and seven. The predictive value of each laboratory marker for SSI was calculated.
The incidence of SSI after elective intestinal fistula resection was 26.7%. Interleukin-6, PCT, and CRP concentrations were higher in patients with SSIs compared with patients without. In contrast, there was no statistical difference for WBC counts between the two groups. Receiver operating characteristic curves demonstrated that IL-6 had the highest diagnostic effectiveness for post-operative SSI on post-operative day one, with an area under the curve of 0.77, and a sensitivity of 85.7% and specificity of 63.9%.
A concentration of IL-6 above 95.6 ng/L on post-operative day one and 52.5 ng/L on post-operative day three, and a concentration of PCT exceeding 0.61 mcg/L predict the occurrence of SSI after definitive operations for gastrointestinal fistulae.
手术部位感染（SSIs）是肠瘘确定性治疗后最常见的并发症之一。包括白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）以及降钙素原（PCT）在内的血清炎症标志物已被用于辅助诊断术后并发症。
本研究的目的是评估炎症标志物，特别是IL-6，在预测肠瘘切除术后手术部位感染方面的临床价值。
前瞻性纳入184例连续接受择期肠瘘切除术的患者。对所有患者进行筛查，排除已有临床感染的患者。术前及术后第1天、第3天和第7天测量血浆IL-6浓度、血清PCT和CRP浓度。计算每个实验室标志物对手术部位感染的预测价值。
择期肠瘘切除术后手术部位感染的发生率为26.7%。与未发生手术部位感染的患者相比，发生手术部位感染的患者的白细胞介素-6、PCT和CRP浓度更高。相比之下，两组患者的白细胞计数无统计学差异。受试者工作特征曲线显示，IL-6在术后第1天对术后手术部位感染的诊断效能最高，曲线下面积为0.77，敏感性为85.7%，特异性为63.9%。
术后第1天IL-6浓度高于95.6 ng/L、术后第3天高于52.5 ng/L，以及PCT浓度超过0.61 mcg/L可预测胃肠道瘘确定性手术后手术部位感染的发生。
