Interleukin-6 as a critical inflammatory marker for early diagnosis of surgical site infection after spine surgery

Paul Jonathan Roch; Carolin Ecker; Katharina Jäckle; Marc-Pascal Meier; Maximilian Reinhold; Friederike Sophie Klockner; Wolfgang Lehmann; Lukas Weiser

doi:10.1007/s15010-024-02271-4

Interleukin-6 as a critical inflammatory marker for early diagnosis of surgical site infection after spine surgery

Infection. 2024 May 6. doi: 10.1007/s15010-024-02271-4. Online ahead of print.

Authors

Paul Jonathan Roch¹, Carolin Ecker², Katharina Jäckle³, Marc-Pascal Meier³, Maximilian Reinhold³, Friederike Sophie Klockner³, Wolfgang Lehmann³, Lukas Weiser³

Affiliations

¹ Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. [email protected].
² Department of Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
³ Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.

PMID: 38709460
DOI: 10.1007/s15010-024-02271-4

Abstract

Purpose: Early diagnosis of surgical site infections (SSIs) could prevent surgical revision. Inflammatory markers (IMs), such as procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), seem more accurate in diagnosing SSI than C-reactive protein (CRP) and white blood cell (WBC) count. The aim was to compare the predictive values of CRP, WBC count, PCT, IL-6, and TNF-α in SSI detection.

Methods: A total of 130 patients undergoing dorsal spondylodesis from 2019 to 2024 were enrolled in a prospective diagnostic study at a maximum care spine center. IMs were measured preoperatively and on the postoperative days (PODs) 1, 2, 3, 5, and 7. Patients with high suspicion of SSI underwent revision surgery. SSI was diagnosed when the microbiological evidence was positive. Patients were divided a posteriori into the non-infection and infection groups.

Results: IMs of 118 patients (66.9 ± 13.0 years, 61.0% females) were measured. Fifteen of the 118 patients (12.7%) developed an SSI. The groups differed with respect to existing hypertension, number of instrumented segments, region of surgery, CRP_POD1,7, PCT_POD7, and IL-6_POD3,5,7. Binary logistic regression for SSI detection including these parameters showed an area under the curve (AUC) of 0.88 (95% CI 0.79-0.98; P < 0.001). The main effect for SSI detection was maintained by IL-6_POD7 (odds ratio = 1.13; 95% CI 1.05-1.23; P = 0.001), which itself showed an AUC of 0.86 (95% CI 0.75-0.97).

Conclusion: Compared to CRP, WBC count, PCT, and TNF-α, IL-6 seems to be the critical IM for the early detection of an SSI.

Trial registration: drks.de: DRKS00033773, date of registration: 29.02.2024, retrospectively registered; Postoperative Markers of Inflammation in Spine Surgery (POMIS) Trial.

Keywords: Inflammatory marker; Interleukin-6; Spine surgery; Surgical site infection.