• K Fassbender, H Pargger, W Müller, and W Zimmerli.
• Department of Anaesthesia, University Hospital, Basel, Switzerland.
• Crit. Care Med. 1993 Aug 1;21(8):1175-80.

ObjectiveTo determine the value of serum concentrations of interleukin-6 (IL-6), C-reactive protein, and glycosylation of alpha 1-acid glycoprotein as tools for diagnosing nosocomial infection in surgical intensive care unit (ICU) patients.DesignProspective, consecutive entry study of patients with an anticipated stay of at least 24 hrs in a surgical ICU.SettingUniversity hospital, a major provider of acute surgical care.PatientsOne hundred four consecutive patients admitted to the surgical ICU between March and June 1990.MeasurementsConcentrations of IL-6, C-reactive protein, and glycosylation of alpha 1-acid glycoprotein were measured on days 1 and 6 after ICU admission. Clinical evaluation for infection was performed daily in a blinded fashion, i.e., without knowing the results of the acute-phase parameters.Main ResultsOn day 6 after surgery or trauma, nosocomial infection could be ascertained in 13 cases. The clinical parameter of fever > 38 degrees C had a sensitivity of 54% and a specificity of 90% to demonstrate nosocomial infection. Infected patients showed increased concentrations of IL-6 (p < .001), C-reactive protein (p < .001), and increased reactivity of alpha 1-acid glycoprotein to concanavalin A (p < .001) compared with patients without infections. By choosing appropriate cutoff values, IL-6 determinations had the highest specificity (97%), and C-reactive protein values had the highest sensitivity (85%) for diagnosing nosocomial infections. In uninfected patients, 81% of the IL-6 values, but only 29% of the C-reactive protein values, were back to the normal range on day 6 after injury.ConclusionDue to the rapid normalization after trauma, a single measurement of the serum IL-6 concentration may be useful to support or refute the clinical suspicion of nosocomial infection.

35 keywords...

hide…