Interleukin-6 as an early marker for fat embolism

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Abstract

Background

Fat Embolism is a complication of long bone fractures, intramedullary fixation and joint arthroplasty. It may progress to fat embolism syndrome, which is rare but involves significant morbidity and can occasionally be fatal. Fat Embolism can be detected at the time of embolization by transoesophageal echocardiography or atrial blood sampling. Later, a combination of clinical signs and symptoms will point towards fat embolism but there is no specific test to confirm the diagnosis. We investigated serum Interleukin-6 (IL-6) as a possible early marker for fat embolism.

Methods

An animal study was conducted to simulate a hip replacement in 31 adult male Sprague Dawley rats. The procedure was performed under general anesthesia and the animals divided into 3 groups: control, uncemented and cemented. Following surgery and recovery from anaesthesia, the rats allowed to freely mobilize in their cages. Blood was taken before surgery and at 6 hours, 12 hours and 24 hours to measure serum IL-6 levels. The rats were euthanized at 24 hours and lungs removed and stained for fat. The amount of fat seen was then correlated with serum IL-6 levels.

Results

No rats in the control group had fat emboli. Numerous fat emboli were seen in both the uncemented and cemented implant groups. The interleukin levels were raised in all groups reaching a peak at 12 hours after surgery reaching 100 pg/ml in the control group and around 250 pg/ml in the uncemented and cemented implant groups. The IL-6 levels in the control group were significantly lower than any of the implant groups at 12 and 24 hours. At these time points, the serum IL-6 correlated with the amount of fat seen on lung histology.

Conclusion

Serum IL-6 is a possible early marker of fat embolism.

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Most cited references 34

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Interleukin-6 gene polymorphism and insulin sensitivity.

Norma Gutiérrez, C Richart, J. Vendrell … (2000)

Type 2 diabetes and the insulin resistance syndrome have been hypothesized to constitute manifestations of an ongoing acute-phase response. We aimed to study an interleukin-6 (IL-6) gene polymorphism in relation to insulin sensitivity (IL-6 is the main cytokine involved in an acute-phase response). Subjects homozygous for the C allele at position -174 of the IL-6 gene (SfaNI genotype), associated to lower plasma IL-6 levels, showed significantly lower integrated area under the curve of serum glucose concentrations (AUCglucose) after an oral glucose tolerance test, lower blood glycosylated hemoglobin, lower fasting insulin levels, lower total and differential white blood cell count (a putative marker of peripheral IL-6 action), and an increased insulin sensitivity index than carriers of the G allele, despite similar age and body composition. A gene dosage effect was especially remarkable for AUCglucose (6.4 vs. 9.3 vs. 9.7 mmol/l in C/C, C/G, and G/G individuals, respectively). The serum concentration of fully glycosylated cortisol binding globulin (another marker of IL-6 action), suggested by concanavalin A adsorption, was lower in C/C subjects than in G/G individuals (32.6+/-2.9 vs. 37.6+/-4.6 mg/l, P = 0.03). In summary, a polymorphism of the IL-6 gene influences the relationship among insulin sensitivity, postload glucose levels, and peripheral white blood cell count.

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Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty.

James F. Preston, Chuan-Pu Liu, P Cesare … (2005)

The erythrocyte sedimentation rate, the C-reactive protein serum level, and the white blood-cell count are routinely used to diagnose periprosthetic infection. In the present study, the diagnostic accuracy of the interleukin-6 serum level was compared with the accuracy of these standard tests for the evaluation of a group of patients who had had a total hip or total knee arthroplasty and were undergoing a reoperation for the treatment of an infection or another implant-related problem. A prospective, case-control study of fifty-eight patients who had had a total hip or knee replacement and were undergoing a reoperation because of an infection (seventeen patients) or another implant-related problem (forty-one patients) was conducted. The serum levels of interleukin-6 and C-reactive protein, the erythrocyte sedimentation rate, and the white blood-cell count were measured. The definitive diagnosis of an infection was determined on the basis of positive histopathological evidence of infection and growth of bacteria on culture of intraoperative specimens. Two-sample Wilcoxon rank-sum (Mann-Whitney) tests were used to determine the presence of a significant difference between patients with and without infection with regard to each laboratory value studied. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each text were also calculated. The serum interleukin-6 level, erythrocyte sedimentation rate, and C-reactive protein level were significantly higher in patients who had an infection than in those who did not, both when all patients were considered together and when the total hip arthroplasty and total knee arthroplasty groups were considered separately. With the numbers available, there was no significant difference with regard to the white blood-cell count between patients with and without infection. With a normal serum interleukin-6 level defined as <10 pg/mL, the serum interleukin-6 test had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 1.0, 0.95, 0.89, 1.0, and 97%, respectively. An elevated serum interleukin-6 level correlated positively with the presence of periprosthetic infection in patients undergoing a reoperation at the site of a total hip or knee arthroplasty. The serum interleukin-6 level is valuable for the diagnosis of periprosthetic infection in patients who have had a total hip or total knee arthroplasty.

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Inflammatory cytokines in animal health and disease.

Michael P Murtaugh, Mary Baarsch, Yaling Zhou … (1996)

Inflammatory cytokines, including tumor necrosis factor (TNF), interleukin-1 (IL-1), IL-6 and IL-8, are rapidly induced early in a disease or injury process. They mediate and modulate myriad healing processes but, if overexpressed, may exacerbate the severity of a disease condition. In order to test this concept and to establish a foundation for the role of inflammatory cytokines in the pathogenesis of gram-negative bacterial infections in the respiratory tract of animals, the patterns of inflammatory cytokine expression were determined in experimental porcine pleuropneumonia. We observed that IL-1 and IL-6, but not TNF, were rapidly and dramatically elevated in the lavage fluid of the lung within 24 h of infection. The increased levels of IL-1 might contribute to increased severity of disease, but elevated IL-6 levels were consistent with a protective acute phase response. Additional studies were performed to examine the hypothesis that IL-4 expression later in infection might be involved in turning off the inflammatory response and promoting an antigen-specific humoral immune response. Interleukin-4 efficiently suppressed inflammatory cytokine production in alveolar macrophages. Its expression was induced in peripheral blood mononuclear cells by TNF, IL-4, and by reexposure to a specific antigen. To obtain the maximum amount of information on the role of inflammatory cytokines in animals of veterinary significance it will be useful to perform studies in species such that evolutionary relatedness will allow widespread application of the findings. Furthermore, the variety of molecules involved in inflammatory cytokine regulation will require much more extensive investigations of the relevant enzymes, inhibitors and receptors in veterinary species. Finally, the complexity and redundancy of immune defenses in animals mean that attempts to modulate health status through manipulation of inflammatory cytokines must be performed with caution and that a multiplicity of processes will be affected.

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Author and article information

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central

ISSN (Electronic): 1749-799X

Publication date Collection: 2009

Publication date (Electronic): 13 June 2009

Volume: 4

Page: 18

Affiliations

[1 ]Department of Orthopaedic Surgery, University of Otago, Dunedin, New Zealand

[2 ]Department of Medicine, University of Otago, Dunedin, New Zealand

Article

Publisher ID: 1749-799X-4-18

DOI: 10.1186/1749-799X-4-18

PMC ID: 2702344

PubMed ID: 19523233

SO-VID: 338fba21-0c48-4609-9582-63e9f2a58ba6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Interleukin-6 as an early marker for fat embolism

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Abstract

Background

Methods

Results

Conclusion

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Most cited references 34

Interleukin-6 gene polymorphism and insulin sensitivity.

Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty.

Inflammatory cytokines in animal health and disease.

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