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Circulating Interleukin-6 as a Prognostic Biomarker for Mortality in Melioidosis: A Systematic Review and
Supphachoke Khemla1, Chaimongkhon Chanthot2, Anchalee Chittamma3
1Division of Infectious Diseases, Department of Internal Medicine, Nakhon Phanom Hospital, Nakhon Phanom 48000, Thailand.
Diseases (Basel, Switzerland)
|December 24, 2025
Summary
Elevated interleukin-6 (IL-6) levels are linked to fatal melioidosis, suggesting IL-6 could be a prognostic biomarker for mortality. Further studies are needed to confirm its role in managing severe cases.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a significant cause of sepsis-related mortality in tropical regions.
- Host inflammatory responses, particularly mediated by Interleukin-6 (IL-6), play a crucial role in melioidosis outcomes, often more than bacterial load.
- The prognostic value of IL-6 in melioidosis sepsis has not been systematically assessed.
Purpose of the Study:
- To systematically evaluate the predictive value of circulating Interleukin-6 (IL-6) concentrations as a prognostic biomarker for mortality in melioidosis.
- To conduct a meta-analysis of studies reporting IL-6 levels in relation to survival outcomes in culture-confirmed melioidosis patients.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines, searching MEDLINE, Embase, and Scopus.
- Four studies with 411 patients reporting IL-6 concentrations stratified by survival outcome were included in the quantitative meta-analysis.
- Random effects models were used to pool standardized mean differences (SMDs) for IL-6 levels between survivors and non-survivors.
Main Results:
- Pooled analysis revealed significantly higher IL-6 levels in non-survivors compared to survivors (SMD = 0.80, 95% CI 0.02-1.57).
- Substantial heterogeneity was observed (I² = 86.3%), but leave-one-out analysis indicated no single study dominated the results.
- Sensitivity analysis excluding the largest dataset reduced heterogeneity and maintained the directional association between IL-6 and mortality.
Conclusions:
- Elevated circulating IL-6 levels are associated with fatal outcomes in melioidosis, indicating its potential as a prognostic biomarker.
- Despite significant heterogeneity and a limited number of studies, the association of IL-6 with mortality was consistent.
- Further prospective, multicenter studies are warranted to validate IL-6 for clinical risk stratification and host-response-guided management in severe melioidosis.
