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Abstract
Purpose
In this prospective study, we evaluated the clinical significance of inflammatory cytokines in women with acute uncomplicated pyelonephritis undergoing antimicrobial therapy.
Materials and Methods
We analyzed 26 female patients diagnosed with acute uncomplicated pyelonephritis between September 2007 and March 2008. Body temperature, white blood cell (WBC) counts, serum C-reactive protein (CRP), and serum and urine interleukin (IL)-6 and IL-8 were measured before and 12 hours, 24 hours, and 4 days after the intravenous administration of empirical ciprofloxacin.
Results
Initial serum CRP levels were correlated with initial serum IL-6 and initial urine IL-8 levels. Twenty-four hours after the start of antibiotic treatment, the CRP level and urine IL-8 level continued to be high, whereas serum IL-6 levels decreased significantly (26.1±32.4 vs 9.9±23.5pg/dl, p<0.01). When we divided the patients into mild (CRP<15mg/dl, n=14) and severe (CRP≥15mg/dl, n=12) groups according to initial CRP levels, the serum IL-6 level decreased significantly in both the mild (14.2±4.0 vs 4.0±1.7pg/dl, p<0.01) and the severe (41.1±12.7 vs. 22.7±16.4pg/dl, p<0.01) groups within 24 hours, whereas CRP and urine IL-8 levels did not change significantly in either group.
Conclusions
Clinically, initial serum IL-6 and urine IL-8 levels were increased according to disease severity. Moreover, the serum IL-6 level decreased rapidly after antibiotic treatment within 24 hours. Serum IL-6 levels are a better indicator of the severity of disease and the therapeutic effect of empirical parenteral antibiotic use in patients with acute uncomplicated pyelonephritis than were either CRP or WBC counts.
Figures and Tables
Fig. 1
Serial changes in variables in patients with acute uncomplicated pyelonephritis in the mild (n=14, CRP<15mg/dl) vs severe (n=12, CRP≥15mg/dl) groups. Serum IL-6 levels declined more rapidly in both the mild and severe groups than did the other inflammation markers within 24 hours.
Table 1
Interrelationships of initial WBC counts, body temperature, CRP, serum IL-6, serum IL-8, urine IL-6, and urine IL-8 by Spearman correlation coefficient
Table 2
Levels of inflammatory markers and patient characteristics at different stages of the study and significance level by Wilcoxon signed-rank test
*: 4th days indicate before antibiotic administration and 24 hours, 48 hours, and 4th days after antibiotics administration, †: For each marker, the first entry is for the comparison of the values for before and 24 hours after antibiotics administration, the second entry is for the comparison of the values for 24 hours and 48 hours after antibiotics administration, and the third entry is for the comparison of the values for 48 hours after and 4th days after antibiotic administration, WBC: white blood cell, CRP: C-reactive protein, IL: interleukin
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