title: Interleukin-6 at discharge predicts all-cause mortality in patients with sepsis.
abstract: OBJECTIVE
  Interleukin-6 (IL-6) is a proinflammatory cytokine that plays a central role in the pathogenesis of sepsis. We aim to investigate the association between IL-6 and all-cause mortality in patients with sepsis.
  
  
  METHODS
  A cohort of 40 elderly patients with sepsis was identified between March 2009 and June 2010 at Rambam Health Medical Campus, Haifa, Israel. The cohort was followed up for all-cause mortality occurring during the 6 months after hospital discharge. Cox proportional hazard model was used to assess the association between IL-6 and all-cause mortality.
  
  
  RESULTS
  Iinterleukin-6 at discharge had a higher predictive accuracy for all-cause mortality when compared with IL-6 at admission. The area under the curve was 0.752 (P = .015) and 0.545 (P = .661), respectively. Eleven (27.5%) patients died during follow-up; the subjects who died have higher IL-6 levels at discharge (median, 50.6 pg/mL [interquartile range, 39.6-105.9]) compared with survivors at the end of follow-up (median, 35.4 [interquartile range, 15.8-49]; P = .014). The risk of all-cause mortality was higher in subjects with IL-6 levels above the median compared with subjects with lower IL-6 levels (log-rank P = .017). On multivariate Cox proportional analysis, adjusting for the potential confounders, IL-6 at discharge remained an independent predictor for 6 month all-cause mortality (hazard ratio, 6.05 [1.24-24.20]) for levels above the median compared with lower levels.
  
  
  CONCLUSIONS
  Iinterleukin-6 at discharge is an independent predictor of all-cause mortality in patients with sepsis. Compared with IL-6 at admission, IL-6 at discharge better predicts all-cause mortality.
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naffaa
authors.forename: Badira F
authors.initials: BF
authors.lastname: Makhoul
authors.forename: Amjad
authors.initials: A
authors.lastname: Tobia
authors.forename: Marielle
authors.initials: M
authors.lastname: Kaplan
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018805:Sepsis / Q000097:blood / Q000401:mortality*
chemical_list: D015415:Biomarkers; D015850:Interleukin-6