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Interleukin-6: an early marker of bacterial infection in decompensated cirrhosis

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Fifty-seven patients with decompensated cirrhosis were studied prospectively to assess the sensitivity and specificity of early clinical or biological signs of bacterial infection. Among them, 19 had proven infection on admission (7 spontaneous bacterial peritonitis, 5 bacteraemia, 3 urinary tract infections, 2 pneumonia, 1 dental abscess and 1 cholangitis). Fever, polymorphonuclear cell count, fibrinogen and C-reactive protein levels were found to be of little or no help in diagnosing bacterial infection on admission. Interleukin-6 plasma levels were, however, significantly different between infected (median: 1386 pg/ml, range: 237–20 000) and non-infected patients (median: 34 pg/ml, range: 0–4500, p<0.00001). Levels above 200 pg/ml were always found in infected patients, giving a sensitivity of 100% and a specificity of 74%. C-reactive protein correlated weakly with interleukin-6 levels, indicating a defective acute-phase response in cirrhosis. Tumor necrosis factor alpha plasma levels were less sensitive (95%) and specific (68%) for the diagnosis of bacterial infection at a threshold of 50 pg/ml, but were more closely related to a poor patient outcome. In decompensated cirrhosis, interleukin-6 plasma levels on admission provided the most sensitive and specific tool for the diagnosis of bacterial infection.

References (30)

  • TilgH et al.

    Serum levels of cytokines in chronic liver diseases

    Gastroenterology

    (1992)
  • NijstenMWN et al.

    Serum levels of interleukin-6 and acute phase responses

    Lancet

    (1987)
  • WyckeRJ

    Problems of bacterial infection in patients with liver disease

    Gut

    (1987)
  • CastellJV et al.

    Acute phase response of human hepatocytes: regulation of acute phase protein synthesis by interleukin-6

    Hepatology

    (1990)
  • Byl B, Roucloux I, Crusiaux A, Dupont E, Devière J. Tumor necrosis factor-α and interleukin-6 plasma levels in infected...
  • DeanAG et al.

    Epi Info, Version 5: a word processing, database, and statistics program for epidemiology on microcomputers

    (1990)
  • KishimotoT et al.

    Molecular regulation of B lymphocytes response

    Ann Rev Immunol

    (1988)
  • TraceyKJ et al.

    The biology of cachectin/tumor necrosis factor

  • CastellJV et al.

    Plasma clearance, organ distribution and target cells of interleukin-6/hepatocyte stimulating factor in the rat

    Eur J Biochem

    (1988)
  • SonneO et al.

    Cellular targets and receptors for interleukin-6. In vivo and in vitro uptake of IL-6 in liver and hepatocytes

    Eur J Clin Invest

    (1990)
  • FerraioloBL et al.

    Pharmacokinetics and tissue distribution of recombinant human tumor necrosis factor-α in mice

    Drug Metab Dispos

    (1988)
  • DevièreJ et al.

    Excessive bacterial lipopolysaccharide-induced production of monokines in cirrhosis

    Hepatology

    (1990)
  • YoshiokaK et al.

    Tumor necrosis factor-α production by peripheral blood mononuclear cells of patients with chronic liver disease

    Hepatology

    (1989)
  • FongY et al.

    Endotoxemia elicits increased circulating β2-IFN/IL-6 in man

    J Immunol

    (1989)
  • DamasP et al.

    Cytokine serum level during severe sepsis in humans: IL-6 as a marker of severity

    Ann Surg

    (1992)
  • Cited by (0)

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