Reniers Ted, Noordzij Peter G, Veen Eelco J, Hofman Erik F N, Taselaar Anne Marlies, Visser W Anton, van der Heiden Pim, Boeckx Stefan, Emmen Judith M A, Dijkstra Ineke M, Cremer Olaf L, Vernooij Lisette M, Rettig Thijs C D
Department of Anaesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, Zuid-Holland, the Netherlands.
Department of Anaesthesiology and Intensive Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
PLoS One. 2025 Jun 23;20(6):e0326537. doi: 10.1371/journal.pone.0326537. eCollection 2025.
Postoperative hyperinflammation increases infection risk. We hypothesized that interleukin-6 (IL-6) is an early predictor of infection after pulmonary cancer surgery.
A two-centre prospective cohort study, including consecutive elective pulmonary cancer surgery patients. The primary outcome was any postoperative infection within 30 days. Multivariable logistic regression was used to create a core model (age, sex, surgery duration and Charlson comorbidity index) to which maximum IL-6, C-reactive protein (CRP), procalcitonin (PCT) concentrations and white blood cell count (WBC) between start of anaesthesia and 24 hours were added. The predictive performance of the models was assessed.
170 patients were analysed, of whom 38 (22%) developed a postoperative infection. IL-6 concentrations peaked 6 hours postoperatively, whereas CRP had not yet reached peak levels at 24 hours (time of prediction). Maximum IL-6 concentrations were associated with postoperative infection (adjusted odds ratio (aOR) 1.04 per 10 pg/ml, 95% confidence interval (CI) 1.00-1.09, p = 0.047) as was CRP (aOR 1.01 per mg/L, 1.00-1.03, p = 0.032). WBC and PCT were not associated with postoperative infection. The c-statistic of the prediction models that included IL-6 or CRP concentrations were 0.67 (95%CI: 0.56-0.77) and 0.68 (0.57-0.77), respectively, compared to 0.67 (0.56-0.76) for the core model. IL-6 and CRP slightly improved calibration by broadening the range of predicted probabilities. Reclassification did not improve.
Plasma IL-6 and CRP levels observed within 24 hours from the start of surgery are associated with postoperative infection risk, yet the added value of these biomarkers to a simple clinical prediction model seems limited.
术后高炎症反应会增加感染风险。我们假设白细胞介素-6（IL-6）是肺癌手术后感染的早期预测指标。
一项双中心前瞻性队列研究，纳入连续接受择期肺癌手术的患者。主要结局是术后30天内发生的任何感染。采用多变量逻辑回归建立一个核心模型（年龄、性别、手术时长和查尔森合并症指数），并将麻醉开始至24小时内的最大IL-6、C反应蛋白（CRP）、降钙素原（PCT）浓度及白细胞计数（WBC）纳入该模型。评估各模型的预测性能。
分析了170例患者，其中38例（22%）发生了术后感染。IL-6浓度在术后6小时达到峰值，而CRP在24小时（预测时间）时尚未达到峰值水平。最大IL-6浓度与术后感染相关（校正比值比[aOR]为每10 pg/ml 1.04，95%置信区间[CI]为1.00 - 1.09，p = 0.047），CRP也是如此（aOR为每mg/L 1.01，1.00 - 1.03，p = 0.032）。WBC和PCT与术后感染无关。包含IL-6或CRP浓度的预测模型的c统计量分别为0.67（95%CI：0.56 - 0.77）和0.68（0.57 - 0.77），而核心模型的c统计量为0.67（0.56 - 0.76）。IL-6和CRP通过拓宽预测概率范围略微改善了校准。重新分类并无改善。
手术开始后24小时内观察到的血浆IL-6和CRP水平与术后感染风险相关，但这些生物标志物对简单临床预测模型的附加值似乎有限。
