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Lipopolysaccharide binding protein, interleukin-6 and C-reactive protein in acute gastrointestinal infections: value as biomarkers to reduce unnecessary antibiotic therapy

  • Clinical and Epidemiological Study
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Abstract

Aim

Several new biomarkers, such as lipopolysaccharide binding protein (LBP) and interleukin-6 (IL-6), have the potential to determine the severity and outcome of infectious diseases. LBP and IL-6 serum levels have not been reported in patients with gastrointestinal infections. The aim of this study was to compare established markers of infection with new markers, such as LBP and IL-6, in patients with acute gastrointestinal infections

Method

LBP, C-reactive protein (CRP), white blood cell count (WBC) and IL-6 serum levels were determined in patients with acute viral or bacterial (positive stool cultures) gastroenteritis. The final diagnosis and empiric antibiotic use were recorded. In total, medical data on 88 patients with acute gastroenteritis (22 bacterial, 66 viral or nonspecific) were analyzed.

Results

LBP and CRP levels were significantly increased in patients with acute bacterial gastroenteritis [28.5 ± 16.5 vs. 15.2 ± 11.5 μg/mL (p < 0.05) and 10.4 ± 9.6 vs. 3.8 ± 5.5 mg/dL (p < 0.001), respectively]. LBP at a cut-off value of 14.6 μg/mL and CRP at a cut-off value of 1.7 mg/dL distinguished between bacterial and non-bacterial gastrointestinal infection (receiver operator characteristic analysis). Empiric antibiotic therapy was initiated in 82% of patients with bacterial gastroenteritis and in 27% of patients with viral gastroenteritis.

Conclusion

The use of the cut-off values for LBP and CRP determined here would have avoided unnecessary antibiotic therapy in 14 and 11%, of patients respectively. CRP and LBP appear to be superior to IL-6 and WBC as diagnostic markers of bacterial gastrointestinal infection. Cut-off values may be a useful tool to support clinical decision-making on whether or not to initiate empiric antibiotic therapy.

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Abbreviations

CRP:

C-reactive protein

IL-6:

Interleukin 6

LBP:

Lipopolysacchaide binding protein

WBC:

White blood cell count

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Acknowledgments

This study was financially supported by the Björn Steiger Foundation, c/o Herbert Wiethoff, Dorsten, Germany. Our thanks to Elvira Schult for helping to collect the data, to Irene Kunz for excellent technical assistance and to Laurence Browning for carefully reading of the manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Gastroenterology and Medicine, St. Elisabeth Hospital, PO Box 580, 46225, Dorsten, Germany

    C. Elsing, S. Ernst & N. Kayali

  2. Department of Gastroenterology, Infectious Diseases and Intoxications, University of Heidelberg, Heidelberg, Germany

    W. Stremmel

  3. Quality Center for Drug Safety and Diagnostics, Psychatric Services Aargau, Brugg, Switzerland

    S. Harenberg

Authors
  1. C. Elsing
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  2. S. Ernst
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  3. N. Kayali
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  4. W. Stremmel
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Correspondence to C. Elsing.

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Elsing, C., Ernst, S., Kayali, N. et al. Lipopolysaccharide binding protein, interleukin-6 and C-reactive protein in acute gastrointestinal infections: value as biomarkers to reduce unnecessary antibiotic therapy. Infection 39, 327–331 (2011). https://doi.org/10.1007/s15010-011-0117-5

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  • DOI: https://doi.org/10.1007/s15010-011-0117-5

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