title: Value of lipopolysaccharide binding protein, interleukin-6 and C-reactive protein as biomarkers of severity in acute diverticulitis: a prospective study.
abstract: BACKGROUND
  New biomarkers have the capability to predict severity and outcome of infectious diseases. Lipopolysaccharide binding protein (LBP) and Interleukin 6 (IL-6) were determined as new markers in patients with acute diverticulitis and were compared with standard markers such as C-reactive protein (CRP) and white blood cell count (WBC).
  
  
  METHODS
  CRP, IL-6, WBC and LBP were measured in 38 patients at hospital admission and every second day and after colonoscopy. Multi-slice CT scans, ultrasound and early colonoscopy were performed to confirm diagnosis and to detect complications (perforations, stenosis).
  
  
  RESULTS
  CRP, IL-6 and LBP levels one correlated highly with each other and were equally influenced by antibiotic therapy. WBC changes were unremarkable. Severity of the disease (sealed- or non-perforation) was not reflected by the biomarkers. In non-perforated patients, colonoscopy was performed on day 6 (median) after admission with a success rate of 93%. Sealed-perforated patients were examined on median day 11 with a success rate of 60% (p > 0.001). Failure in all cases was due to sigmoidal stenosis requiring surgery. In a receiver-operating characteristic curve analysis (ROC), LBP on day one performed best in predicting colonic steno-sis with an area under the curve of 0.88 (95% CI 0.73 - 0.03 p < 0.02).
  
  
  CONCLUSIONS
  CRP, IL-6, and LBP can be used to monitor diverticulitis. Initial LBP values in patients with acute diverticulitis may also be usefully in detecting candidates for surgical intervention.
authors.affiliation: Department of Gastroenterology, St. Elisabeth Hospital, Dorsten, Germany. dr.c.elsing@kkrn.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Elsing
authors.forename: Susanne
authors.initials: S
authors.lastname: Ernst
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D002352:Carrier Proteins / Q000097:blood*; D003113:Colonoscopy; D004239:Diverticulitis, Colonic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein; D002352:Carrier Proteins; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein