title: Serum Concentrations of Interleukin-6, Procalcitonin, and C-Reactive Protein: Discrimination of Septical Complications and Systemic Inflammatory Response Syndrome after Pediatric Surgery.
abstract: BACKGROUND
  Early differentiation between sepsis and systemic inflammatory response syndrome (SIRS) is useful for therapeutic management in neonates and infants after surgery.
  
  
  OBJECTIVE
  To compare the early (first 2 days) diagnostic value of interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) after surgery in the differentiation of subsequent SIRS and septic complications.
  
  
  METHODS
  IL-6, PCT, and CRP were measured 0, 24, and 48 hours after surgery in neonates and infants with clinical suspicion of postoperative sepsis. Sensitivity, specificity, and predictive values for SIRS/septic complications were calculated.
  
  
  RESULTS
  A total of 31 out of 205 neonates and infants showed clinical signs for postoperative sepsis and underwent sepsis work-up. Nine patients developed septic complications, sixteen patients met criteria for SIRS, and six patients showed an uneventful postoperative course during the first five postoperative days. IL-6, PCT, and CRP levels increased in all subgroups after surgery and were significantly higher in the sepsis group (p < 0.05). IL-6 peaked immediately, CRP at 24 to 48 hours, and PCT at 24 hours after surgery. Sensitivity and specificity (area under the curve) for IL-6 (cutoff 673 ng/dL) were 94.4 and 75% (86.2%), for CRP (cutoff 1.48 mg/dL) 76.2 and 75.0% (88.1%), and for PCT (cutoff 16.1 mg/L) 66.7 and 57.1% (65.6%).
  
  
  CONCLUSIONS
  IL-6 appears to be an early marker for severe bacterial infections with high sensitivity. IL-6 and CRP were the most reliable markers for the discrimination between SIRS and sepsis within the postoperative period.
authors: Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
authors: Felix
authors: F
authors: Neunhoeffer
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany.
authors: Swantje
authors: S
authors: Plinke
authors: Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
authors: Hanna
authors: H
authors: Renk
authors: Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
authors: Michael
authors: M
authors: Hofbeck
authors: Department Pediatric Surgery, University of Tübingen, Tübingen, Germany.
authors: Jörg
authors: J
authors: Fuchs
authors: Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
authors: Matthias
authors: M
authors: Kumpf
authors: Department Pediatric Surgery, University of Tübingen, Tübingen, Germany.
authors: Sabine
authors: S
authors: Zundel
authors: Department Pediatric Surgery, University of Tübingen, Tübingen, Germany.
authors: Guido
authors: G
authors: Seitz
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D015850:Interleukin-6 / Q000097:blood*; D000071074:Neonatal Sepsis / Q000097:blood / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002116:Calcitonin; D002097:C-Reactive Protein