Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery.
OBJECTIVE
Postoperative infections should be detected earlier. We investigated the efficacy of the National Nosocomial Infection Surveillance (NNIS) score, interleukin-6 (IL-6) and various acute-phase proteins for predicting postoperative infections.


METHODS
Case series study at the Júlio Müller University Hospital.


METHODS
Thirty-two patients who underwent major gastrointestinal procedures between June 2004 and February 2005 were studied. The NNIS score and the evolution of serum IL-6 and various acute-phase proteins (C-reactive protein [CRP], albumin, prealbumin and transferrin) were correlated with postoperative infections and length of hospital stay (LOS).


RESULTS
NNIS > 1 (p = 0.01) and low preoperative albumin (p = 0.02) significantly correlated with infection. IL-6 and CRP increased significantly more in patients with infections. Multivariate analysis showed greater risk of infection when NNIS > 1 (odds ratio, OR = 10.66; 95% confidence interval, CI: 1.1-102.0; p = 0.04); preoperative albumin < 3 g/dl (OR = 8.77; 95% CI: 1.13-67.86; p = 0.03); CRP > 30 mg/l on the second postoperative day (OR = 8.27; 95% CI: 1.05-64.79; p = 0.03) and > 12 mg/l on the fifth postoperative day (OR = 25.92; 95% CI: 2.17-332.71; p < 0.01); and IL-6 > 25 pg/ml on the fifth postoperative day (OR = 15.46; 95% CI: 1.19-230.30; p = 0.03). Longer LOS was associated with cancer, transferrin, IL-6 and albumin (p < 0.05).


CONCLUSIONS
NNIS, albumin, CRP and IL-6 may be useful as predictive markers for postoperative infections. For predicting LOS, malignant condition, transferrin, albumin and IL-6 are useful.
Aguilar-Nascimento
José Eduardo de
JE
Department of Surgery, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso, CEP 78043-300, Brazil. aguilar@terra.com.br
Marra
Jair Gimenez
JG
Slhessarenko
Natasha
N
Fontes
Cor Jesus Fernandes
CJ
D000209:Acute-Phase Proteins / Q000032:analysis* / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D015850:Interleukin-6 / Q000097:blood* / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality
D000209:Acute-Phase Proteins; D015415:Biomarkers; D015850:Interleukin-6