title: Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.
abstract: OBJECTIVE
  To assess the potential role of amniotic fluid (AF) matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.
  
  
  METHODS
  Eighty-four women with singleton gestations with preterm contraction, preterm labor, preterm premature rupture of membranes, or clinical suspicion of intra-amniotic infection were studied. Amniotic fluid was obtained by transabdominal amniocentesis before starting any treatment. Intra-amniotic infection was defined as the presence of a positive AF culture. Amniotic fluid glucose concentration, leukocytes, matrix metalloproteinase-9, and interleukin-6 were determined.
  
  
  RESULTS
  Amniotic fluid matrix metalloproteinase-9 and interleukin-6 levels were significantly higher in women with intra-amniotic infection than in those without. With intra-amniotic infection, levels of matrix metalloproteinase-9 significantly correlated with interleukin-6 (r = 0.813, P <.001). Each of matrix metalloproteinase-9 and interleukin-6 significantly correlated with AF leukocytes and inversely correlated with AF glucose. Using AF cutoff levels of 13.6 ng/mL for matrix metalloproteinase-9 and 11.4 ng/mL for interleukin-6, the sensitivity, specificity, and positive and negative predictive values for diagnosing intra-amniotic infection were 77% versus 73%, 100% versus 79%, 100% versus 61%, and 90% versus 86%, respectively. Combining AF matrix metalloproteinase-9 with interleukin-6 slightly improved the sensitivity and the negative predictive values in diagnosing intra-amniotic infection.
  
  
  CONCLUSIONS
  Amniotic fluid matrix metalloproteinase-9 and interleukin-6 are significantly elevated in women with intra-amniotic infection. Amniotic fluid matrix metalloproteinase-9 is an accurate biochemical marker in predicting intra-amniotic infection with better sensitivity, specificity, and positive and negative predictive values than interleukin-6.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas 77555-0587, USA. hmharira@utmb.edu
authors.forename: Hassan
authors.initials: H
authors.lastname: Harirah
authors.forename: Sahar E
authors.initials: SE
authors.lastname: Donia
authors.forename: Chaur Dong
authors.initials: CD
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000379:methods; D000653:Amniotic Fluid / Q000737:chemistry*; D001424:Bacterial Infections / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000382:microbiology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis*; D020780:Matrix Metalloproteinase 9 / Q000032:analysis*; D007752:Obstetric Labor, Premature / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D020780:Matrix Metalloproteinase 9