Clinical application of maternal serum cytokine determination in premature rupture of membranes--interleukin-6, an early predictor of neonatal infection?
BACKGROUND
In cases of premature rupture of membranes (PROM), an early detection of fetal infection is necessary in order to weigh infectious complications against prematurity. As routine parameters (leukocytes, C-reactive protein (CRP), fever, and fetal tachycardia) lack satisfactory sensitivity and specificity, this study evaluates whether the determination of interleukin-6 (IL-6), interleukin-8 (IL-8) or soluble interleukin-2 receptor (IL-2R) in maternal serum could supplement or replace routine inflammation parameters.


METHODS
In this prospective study results of clinical and laboratory parameters were investigated with respect to neonatal infection in 71 patients with PROM. IL-6, IL-8 and IL-2R were determined by enzyme immunoassays.


RESULTS
Best specificity and sensitivity could be demonstrated for CRP and IL-6. Both elevation of CRP and IL-6 correlated significantly (p<0.01 and p<0.001, respectively) with the onset of neonatal infection. At a cutoff of 11 pg/ml, IL-6 reaches a sensitivity of 81% and a specificity of 76%; CRP a specificity of 76% (cutoff 1.2 mg/dl) and a sensitivity of 56%. In 4/16 (25%) cases developing neonatal infection, IL-6 increased earlier than CRP. IL-8 and IL-2R results showed a less significant correlation with fetal outcome.


CONCLUSIONS
Determination of IL-6 in maternal serum can significantly contribute to an earlier detection of fetal infection in patients with PROM.
Pfeiffer
K A
KA
Department of Gynecology and Obstetrics, University of Bonn, Germany.
Reinsberg
J
J
Rahmun
A
A
Schmolling
J
J
Krebs
D
D
D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood; D007964:Leukocytosis / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012372:ROC Curve; D015375:Receptors, Interleukin-2 / Q000097:blood; D012680:Sensitivity and Specificity; D013997:Time Factors
D015850:Interleukin-6; D016209:Interleukin-8; D015375:Receptors, Interleukin-2; D002097:C-Reactive Protein