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Interleukin-6 and interleukin-8 in newborn bacterial infection
S S Mehr1, L W Doyle, G E Rice
1Division of Newborn Services, The Royal Women's Hospital, Carlton, Australia.
Insights
Interleukin-6 (IL-6) and interleukin-8 (IL-8) show promise as early infection markers in newborns. Higher concentrations indicate definite infection, aiding in early diagnosis.
Area of Science:
- Neonatal immunology
- Infectious disease diagnostics
Background:
- Newborn infections pose significant health risks.
- Accurate and early diagnostic markers are crucial for timely intervention.
- Cytokines like IL-6 and IL-8 are implicated in inflammatory responses.
Purpose of the Study:
- To evaluate plasma concentrations and diagnostic accuracy of IL-6 and IL-8 in neonatal infections.
- To establish cut-off values for IL-6 and IL-8 for diagnosing newborn infections.
Main Methods:
- Prospective study of 101 neonates with clinical signs of infection.
- Assessed blood cultures, CRP, FBE, and IL-6/IL-8 cytokine levels.
- Classified infection severity into definite, probable, uncertain, and nil groups.
Main Results:
- Significantly higher median IL-6 and IL-8 concentrations in definitely infected neonates (p <0.05).
- Optimal cut-offs: IL-6 >175 pg/mL (80% sensitivity, 91% specificity) and IL-8 >28 pg/mL (82% sensitivity, 81% specificity).
- Improved sensitivities achieved (90% for IL-6, 100% for IL-8) with >50% specificity, though confidence intervals were wide.
Conclusions:
- Elevated IL-6 and IL-8 levels are early indicators of definite infection in newborns.
- These cytokines demonstrate potential as diagnostic markers, particularly IL-6.
- Diagnostic accuracy was limited in cases of probable infection.
Abstract:
The objective of this study is to determine the plasma concentrations and diagnostic accuracy of interleukin-6 (IL-6) and interleukin-8 (IL-8) in newborn infection. One hundred and one newborn infants with clinical signs of infection during their primary hospitalization were investigated with the minimum of a blood culture, C-reactive protein (CRP), full blood examination (FBE), and cytokine concentrations (IL-6 and IL-8). Infection in infants was classified without knowledge of cytokine levels into four groups-definite (n = 11), probable (n = 12), uncertain (n = 52), and nil (n = 26). The median concentrations of IL-6 and IL-8 were significantly higher in the definitely infected group compared with the other three groups (p <0.05). At the cut-off concentration of highest accuracy, IL-6 (>175 pg/mL) and IL-8 (>28 pg/mL) had similar sensitivities (80 and 82%, respectively) and specificities (91 and 81%, respectively). Cut-off concentrations could be identified with improved sensitivities (90% for IL-6 and 100% for IL-8) that maintained specificity >50%. However, the confidence intervals were wide for all sensitivities and specificities. IL-6 and IL-8 had little diagnostic accuracy in infants with probable infection. IL-6 and IL-8 concentrations increase early in newborn infants with definite infection.