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Using IL-6 concentrations in the first 24 h following trauma to predict immunological complications and mortality in trauma patients: a meta-analysis

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Abstract

Purpose

In previous studies, interleukin-6 (IL-6) has been shown to have a high predictive value for the development of complications and mortality after trauma; however, there is some uncertainty around these results. The aim of this meta-analysis was to assess the value of early IL-6 levels (within the first 24 h after trauma) for predicting post-traumatic complications [acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), sepsis, multiple organ failure (MOF), and multiple organ dysfunction syndrome (MODS)] and mortality.

Methods

A systemic literature review (from January 01, 1990, to June 03, 2017) of English-language articles was carried out using Pubmed, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science. The search terms used were IL-6 (IL6, IL-6, interleukin 6, or interleukin-6); trauma (trauma*, polytrauma*, multitrauma*, injury, or injury severity score); complications (complication*, ARDS, SIRS, sepsis, MOF, or MODS); and mortality (survival, death). Eleven publications (775 patients) out of 1812 fulfilled the criteria. Fixed-effective models were used for data analysis. Statistical heterogeneity was estimated by a Chi-squared Q test and I 2 statistics, and publication bias was assessed with Egger’s test.

Results

Results showed that the concentrations of IL-6 within the first 24 h after trauma were significantly higher in the group of patients who had complications or who died [standardized mean difference (SMD) = 0.399; 95% confidence interval (CI) 0.217, 0.580; I 2 = 0.0%; P(heterogeneity) = 0.489]. Subgroup results showed a significant correlation for mortality [SMD = 0.610; 95% CI 0.322, 0.898; I 2 = 0.0%; P(heterogeneity) = 0.708] and MOF/MODS [SMD = 0.334; 95% CI 0.028, 0.639; I 2 = 0.0%; P(heterogeneity) = 0.512] with IL-6, but not for sepsis [SMD = 0.194; 95% CI − 0.095, 0.484; I 2 = 0.0%; P(heterogeneity) = 0.512]. Significance was also found in both ISS ≥ 9 [SMD = 0.461, 95% CI 0.131, 0.791, I 2 = 5.6%, P(heterogeneity) = 0.365] and ISS ≥ 16 [SMD = 0.372, 95% CI 0.155, 0.588, I 2 = 1.5%, P(heterogeneity) = 0.413].

Conclusion

In conclusion, this meta-analysis showed that serum concentration of IL-6 within the first 24 h after trauma could be useful for the prediction of post-traumatic complications, particularly MOF/MODS and mortality.

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Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstreet 30, 52074, Aachen, Germany

    Zhi Qiao, Weikang Wang, Luxu Yin, Peng Luo, Johannes Greven, Klemens Horst & Frank Hildebrand

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Correspondence to Zhi Qiao.

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Zhi Qiao is supported by the China Scholarship council (no. 201508080049). Weikang Wang, Luxu Yin, Peng Luo, Johannes Greven, Klemens Horst, and Frank Hildebrand declare that they have no conflict of interest.

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Qiao, Z., Wang, W., Yin, L. et al. Using IL-6 concentrations in the first 24 h following trauma to predict immunological complications and mortality in trauma patients: a meta-analysis. Eur J Trauma Emerg Surg 44, 679–687 (2018). https://doi.org/10.1007/s00068-017-0880-9

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