Diagnostic Performance of Serum Interleukin-6 versus Procalcitonin as Early Biomarkers for Severe Acute Cholangitis

International Journal of Medicine and Medical Sciences | Vol. 11, No. 6, June 2021 | pp. 41–48

DOI: 10.46882/2021/IJMMS/110041

Original Research Article

Diagnostic Performance of Serum Interleukin-6 versus Procalcitonin as Early Biomarkers for Severe Acute Cholangitis

Charles O. Igwe¹, Rachel L. Sanon², Anthony D. Boateng¹*

¹Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

²Department of Gastroenterology, Faculty of Health Sciences, Université de Ouagadougou, Ouagadougou, Burkina Faso.

Abstract:

Acute cholangitis is a life-threatening biliary infection that requires rapid risk stratification to prevent systemic septic shock. This prospective diagnostic study evaluated and compared the performance of serum Interleukin-6 (IL-6) and procalcitonin (PCT) as early biochemical indicators for severe acute cholangitis. We evaluated 115 adult patients admitted with confirmed acute cholangitis within 24 hours of symptom onset. Patients were classified into mild/moderate (n = 75) or severe (n = 40) groups according to the Tokyo Guidelines (TG13/TG18) grading criteria. Serum IL-6 and PCT concentrations were measured via enzyme-linked immunosorbent assay (ELISA) at admission, and diagnostic utilities were assessed using Receiver Operating Characteristic (ROC) curves. Serum IL-6 at a cutoff value of 120 pg/mL demonstrated a sensitivity of 90.0%, specificity of 84.0%, positive predictive value (PPV) of 75.0%, and negative predictive value (NPV) of 94.0% for identifying severe cases. In comparison, serum PCT at a cutoff value of 3.5 ng/mL showed a sensitivity of 80.0%, specificity of 78.7%, PPV of 66.7%, and NPV of 88.1%. The Area Under the Curve (AUC) was significantly larger for IL-6 (AUC = 0.91, 95% CI = 0.85–0.97) than for PCT (AUC = 0.82, 95% CI = 0.73–0.91, p < 0.05). Combining both inflammatory biomarkers significantly enhanced the overall diagnostic sensitivity to 95.0% and the NPV to 96.7%. Serum IL-6 offers superior early diagnostic accuracy and sensitivity compared to procalcitonin in predicting severity in acute cholangitis, serving as an effective clinical tool to guide urgent biliary decompression interventions.

Keywords: Acute Cholangitis, Interleukin-6, Procalcitonin, Biomarkers, Diagnostic Accuracy, Biliary Sepsis

Manuscript Timeline: Received: February 18, 2021; Revised: March 25, 2021; Accepted: April 20, 2021; Published: June 15, 2021.

Citation: Igwe CO, Sanon RL, Boateng AD. Diagnostic Performance of Serum Interleukin-6 versus Procalcitonin as Early Biomarkers for Severe Acute Cholangitis. International Journal of Medicine and Medical Sciences, 2021, 11(6): 41–48. DOI: 10.46882/2021/IJMMS/110041

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