A surgical study of serological markers such as C-reactive protein and interleukin 6 in response to postoperative infection in patients with open fractures in a tertiary care hospital

J. P. V. Jebaraj, B. Ezhil Rajan, N. Ashok Viswanath, R. Preethy


To study the response of C-reactive protein (CRP) and interleukin-6 (IL-6) to postoperative infection in patients with open fractures. Thirty patients with open fractures of extremities within 12 hours of injury were included in study. Blood samples were collected for Postoperative infection is a devastating complication of open fractures. The ideal investigation for early diagnosis of infection should be done before surgery and should be accurate, convenient to patient, cause minimal morbidity. Test such as CRP and IL-6 estimation is utilized in this study. CRP and IL 6 estimation on admission, second and fourth post-op day. All patients underwent surgery and reports evaluated. It was observed that CRP peak on post-op day 4 and IL 6 on postoperative day 2 in patients with infection before clinical evidence of infection. This prospective study includes 30 cases, followed up in ward for a week. Various factors regarding clinical presentation, findings of various investigations, operative treatment had been analyzed. The sensitivity of CRP in our study was 100%, and specificity was 42%. The persistent rise of CRP value seen within the infected group was statistically significant (p<0.05). The present clinical study of estimation of CRP and IL 6 to detect postoperative infection in patients after open fractures is an excellent diagnostic test for early detection and management of infection.


Postoperative infection, Acute phase reactants CRP, IL-6, Open fractures

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Greidanus NV, Masri BA, Donald. Use of Erythrocyte Sedimentation Rate and C reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg. 2007;89:1409-16.

Hussain TM, David C. C reactive protein and Erythrocyte sedimentation rate in orthopaedics. Sring. 2002;15:13-6.

Kallio P, Michelsson JE. C-reactive protein in tibial fractures: Natural response to injury and operative treatment. J Bone Joint Surg. 1990;72-B:615-7.

Gupta R, Singh R, Soni M. C-reactive protein (CRP) as an indicator of sepsis in orthopaedic trauma. Indian J Med Sci. 2002;56(10):501-7.

Kragsbjerg P, Holmberg H, Vikerfors T. Serum concentrations of interleukin-6, tumour necrosis factor-alpha, and c-reactive protein in patients undergoing major operations. Eur J Surg. 1995;161(1):17-22

Di Cesare PE, Chang E. Serum interleukin 6 as a marker of periprosthetic infection following total hip and knee arthroplasy. J Bone Joint Surg. 2005;87:1921-7.

D’Auria L, Bonifati C, Mussi A, D’Agosto G, De Simone C, Giacalone B et al. Cytokines in the sera of patients with pemphigus vulgaris: interleukin-6 and tumour necrosis factor-alpha levels are significantly increased as compared with healthy subjects and correlate with disease activity. Eur Cytokine Netw. 1997;8:383-7.

Yamamura M, Yamada Y, Momita S, Kamihara S, Tomonaga M. Circulating interleukin-6 levels are elevated in adult T-cell leukaemia/lymphoma patients and correlate with adverse clinical features and survival. Br J Haematol. 1998;100:129-34.

Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci. 1990;79:161-5.

Pape HC, Remmers D, Grotz M, Kotzerke J, Von Glinski S, Van Griensven M et al. Reticuloendothelial system activity and failure in patients with multiple injuries. Arch Surg. 1999;134:421-7.

Pape HC, Schmidt RE, Rice J, Van Griensven M, Das Gupta R, Krettek C et al. Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med. 2000;28:3441-8.

Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM. Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop. 2000;24:194-6.

White J, Kelly M, Dunsmuir R. C-reactive protein level after total hip and total knee replacement. J Bone joint Surg Br. 1998;80:909-11.

Niskanen RO, Korkala O, Pammo H. Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br. 1996;78:431-3.

Aguilar-Nascimento JE, Marra JG, Slhessarenko N, Fontes CJ. Efficacy of National Nosocomial Infection Surveillance Score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery. Sao Paulo Med J. 2007;125(1):34-41.

Kristiansson M, Soop M, Saraste L. Post-operative circulating cytokine patterns-the influence of infection. Intensive Care Med. 1993;19(7):395-400.

Vanderschueren S, Deeren D, Knockaert DC, Bobbaers H, Bossuyt X, Peetermans W. Extremely elevated C-reactive protein. Eur J Intern Med. 2006;17(6):430-3.

Kishimoto T. Interleukin-6: From basic science to medicine-40 years in immunology. Annu Rev Immunol. 2005;23:1-21.