Interleukin-6 as inflammatory marker of surgical site infection following spinal surgery
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ORIGINAL ARTICLE - INFECTION
Interleukin-6 as inflammatory marker of surgical site infection following spinal surgery Markus Lenski 1 & Joerg-Christian Tonn 1 & Sebastian Siller 1 Received: 14 July 2020 / Accepted: 22 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background In order to elucidate whether serum inflammatory markers identify patients with local surgical site infection(SSI) as underlying disease for recurrent or new symptomatology following spine surgery, we evaluated the diagnostic potential of interleukin-6(IL-6) as a marker of SSI. The diagnostic significance of IL-6 was compared to the standard serum inflammatory markers C-reactive protein(CRP) and white blood cell count (WBCC). Method Ninety-eight consecutive patients with readmission due to recurrent or new symptomology after spinal surgery of degenerative spine disorders entered the study. Baseline patients’ characteristics and the abovementioned inflammatory markers were collected, and arithmetical means with standard deviation, area under the curve (AUC), thresholds, sensitivity, specificity, positive(+)likelihood ratio (LR), and negative(−)LR with corresponding 95% confidence interval(95%CI) were calculated and correlated with presence or absence of SSI. Results Nine patients suffered from a SSI, whereas the remaining 89 patients had a recurrent/adjacent-segment degenerative disorder without evidence of infection. The most significant parameter for diagnosing a SSI was serum IL-6 (cut-off value > 15.3 pg/ml, AUC = 0.954, SE = 85.7%, SP = 97.3%), followed by CRP (cut-off value = 0.8 mg/dl, AUC = 0.916, SE = 88.9%, SP = 84.5%) Conclusions In the case of recurrent or new symptomatology following spinal surgery, serum IL-6 has the highest diagnostic potential for diagnosing spinal SSI. Keywords Spine surgery . Surgical site infection . Inflammatory marker . Interleukin-6 . IL-6 . C-reactive protein
Introduction Despite all careful precautionary measures to avoid surgical site infections (SSI) following spinal surgery, the incidence of SSI after decompressed laminectomy is about 3% and even higher in association with fusion and instrumentation surgery with up to 12% [13]. Discitis occurs in 0.2 to 2.7% and is therefore a rare complication of spine surgery [13]. Further, different surgical techniques with individual level of invasiveness may explain the difference in the reported incidence of spinal SSIs [8, This article is part of the Topical Collection on Infection Presentation at a conference: 71st annual meeting of the German society for neurosurgery 2020. * Markus Lenski [email protected] 1
Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
31, 46]. In a meta-analysis, SSI was the most common cause of re-admission after spinal surgery [5]. Severe infections causing significant morbidity and mortality occurred in up to 1% of spinal surgeries, leading to profound complications such as
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