role of IL-6 for predicting neonatal sepsis: a systematic review and meta-analysis

ABSTRACT

Neonatal sepsis [NS] is a common and life-threatening disorder in infants. Previous studies showed that interleukin-6 [IL-6] may be a valid non-invasive and rapid method for diagnosis of NS. We conducted this review to assess the validity of IL-6 for predicting NS. This was a systematic review with meta-analysis. Embase, Medline and Web of Science databases were searched between January 1990 and December 2009. The search terms used were [cytokine], [neonate], [sepsis] and [interleukin-6]. We used standard methods recommended for meta analyses of diagnostic test evaluations. The analysis was based on a summary ROC [SROC] curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of meta-analysis. Potential presence of publication bias was tested using funnel plots and the Egger test. Meta-analysis was performed on 13 publications including 353 infants with sepsis and 691 control infants. The pooled sensitivity and specificity of IL-6 was 0.79 and 0.84, respectively. The maximum joint sensitivity and specificity [i.e., the Q value] in SROC curve was 0.82 and the area under curve [AUC] was 0.89 [95% CI 0.84-0.94]. Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables. The evaluation of publication bias showed that the Egger test was not significant [P=0.07]. IL-6 seems to be a valid marker for predicting NS. It may be considered for early diagnosis of sepsis in neonatal care units