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Bedside assessment of amniotic fluid interleukin-6 in preterm prelabor rupture of membranes
Marian Kacerovsky1, Ivana Musilova2, Helena Hornychova3
1Biomedical Research Center, University Hospital Hradec Kralove, Czech Republic; Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Czech Republic.
Objective:
The objective of the study was to determine the diagnostic indices and predictive values by bedside assessment of amniotic fluid interleukin-6 (IL-6) concentration in the identification of microbial invasion of the amniotic cavity (MIAC) and/or histological chorioamnionitis (HCA) in patients with preterm prelabor rupture of membranes.
Study Design:
One hundred twenty-four women with singleton pregnancies were included in this study. The amniotic fluid was sampled by transabdominal amniocentesis at the time of admission. IL-6 concentrations were assessed with an immunoassay.
Results:
The presence of MIAC, HCA, or the coexistence of both was associated with higher amniotic fluid concentrations of IL-6 in both a crude and adjusted analysis. The amniotic fluid concentration of IL-6 of 1000 pg/mL was determined to be the best cutoff value for the prediction of MIAC (sensitivity of 50%, specificity of 95%, positive predictive value of 82%, negative predictive value of 81%, and likelihood ratio of 8.4) or both MIAC and HCA (sensitivity of 60%, specificity of 94%, positive predictive value of 75%, negative predictive value of 88%, and likelihood ratio of 9.4).
Conclusion:
The bedside assessment of amniotic fluid IL-6 seems to be an easy, rapid, and inexpensive method for the prediction of MIAC or both MIAC and HCA in pregnancies complicated by preterm prelabor rupture of membranes.
Insights
Bedside assessment of amniotic fluid interleukin-6 (IL-6) can effectively predict microbial invasion of the amniotic cavity (MIAC) or histological chorioamnionitis (HCA) in preterm prelabor rupture of membranes. This rapid test aids in diagnosing intra-amniotic infections.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Diagnostics
Background:
- Preterm prelabor rupture of membranes (PPROM) increases the risk of intra-amniotic infection.
- Accurate and timely diagnosis of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) is crucial for managing PPROM.
- Current diagnostic methods may be invasive or time-consuming.
Purpose of the Study:
- To evaluate the diagnostic accuracy of bedside amniotic fluid interleukin-6 (IL-6) levels.
- To determine the predictive value of IL-6 for MIAC and/or HCA in patients with PPROM.
- To establish an optimal IL-6 cutoff for clinical use.
Main Methods:
- Transabdominal amniocentesis for amniotic fluid sampling in 124 women with singleton pregnancies and PPROM.
- Quantification of amniotic fluid IL-6 concentrations using an immunoassay.
- Statistical analysis to determine diagnostic indices and predictive values.
Main Results:
- Elevated amniotic fluid IL-6 concentrations were significantly associated with MIAC, HCA, or both.
- An IL-6 cutoff of 1000 pg/mL demonstrated high specificity (95%) for predicting MIAC and (94%) for predicting both MIAC and HCA.
- The positive predictive values were 82% for MIAC and 75% for MIAC/HCA, with negative predictive values of 81% and 88%, respectively.
Conclusions:
- Bedside assessment of amniotic fluid IL-6 is a valuable tool for predicting intra-amniotic infection in PPROM.
- IL-6 measurement offers a rapid, easy, and cost-effective diagnostic approach.
- This method can aid clinicians in timely management decisions for PPROM complicated by infection.
