The value of plasma cytokine measurement for the detection of strangulation in patients with bowel obstruction: a prospective, pilot study.
OBJECTIVE
The aim of this prospective blinded study was to examine whether measurement of plasma cytokines is a predictor of strangulation in patients with bowel obstruction.


METHODS
Seventy-seven consecutive patients diagnosed with bowel obstruction were included. Blood samples were obtained at enrollment in all patients and at surgery (immediately before operation) if patients required surgery.


RESULTS
Forty-three patients were managed conservatively (group 1) and 34 patients required surgery, of whom 20 had no bowel strangulation (group 2) and 14 had bowel strangulation (group 3). The mean plasma interleukin (IL)-6 levels at enrollment were significantly higher in group 3 (107.8 pg/ml) than in groups 1 (11.3 pg/ml, P < 0.0001 vs. group 3) and 2 (23.6 pg/ml, P < 0.0001 vs. group 3). The sensitivity and specificity of plasma IL-6 level (> or = 40 pg/ml) in predicting strangulation were 86 percent (95 percent confidence interval, 60-97 percent) and 86 percent (95 percent confidence interval, 80-88 percent), respectively. The plasma IL-6 levels at surgery significantly increased compared to those at enrollment (from 107.8 pg/ml to 205.8 pg/ml, P = 0.0003) in group 3, however, they did not increase significantly in group 2. Among other clinical and laboratory parameters, plasma lactic acid levels (> or = 15 mg/dl) at enrollment were significantly associated with strangulation. In the multivariate analysis, both plasma IL-6 (</> or = 40 pg/ml) and lactic acid (</> or =15 mg/dl) levels at enrollment were significant predictive factors for strangulation. IL-1beta and tumor necrosis factor-alpha were not detected in the plasma of most patients during the study.


CONCLUSIONS
Plasma IL-6 measurement might be an additional diagnostic tool that can predict strangulation in patients with bowel obstruction.
Yamamoto
Takayuki
T
Department of Surgery, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan. nao-taka@sannet.ne.jp
Umegae
Satoru
S
Kitagawa
Tatsushi
T
Matsumoto
Koichi
K
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D007415:Intestinal Obstruction / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha