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Value of Lipopolysaccharide Binding Protein, Interleukin-6 and C-reactive Protein as Biomarkers of Severity in Acute Diverticulitis: A Prospective Study by Christoph Elsing, Susanne Ernst, Wolfgang Stremmel

Background: New biomarkers have the capability to predict severity and outcome of infectious diseases. Lipopolysaccharide binding protein (LBP) and Interleukin 6 (IL-6) were determined as new markers in patients with acute diverticulitis and were compared with standard markers such as C-reactive protein (CRP) and white blood cell count (WBC).
Methods: CRP, IL-6, WBC and LBP were measured in 38 patients at hospital admission and every second day and after colonoscopy. Multislice CT scans, ultrasound and early colonoscopy were performed to confirm diagnosis and to detect complications (perforations, stenosis).
Results: CRP, IL-6 and LBP levels one correlated highly with each other and were equally influenced by antibiotic therapy. WBC changes were unremarkable. Severity of the disease (sealed- or non-perforation) was not reflected by the biomarkers. In non-perforated patients, colonoscopy was performed on day 6 (median) after admission with a success rate of 93%. Sealed-perforated patients were examined on median day 11 with a success rate of 60% (p>0.001). Failure in all cases was due to sigmoidal stenosis requiring surgery. In a receiver-operating characteristic curve analysis (ROC), LBP on day one performed best in predicting colonic stenosis with an area under the curve of 0.88 (95% CI 0.73 - 0.03 p<0.02).
Conclusions: CRP, IL-6, and LBP can be used to monitor diverticulitis. Initial LBP values in patients with acute diverticulitis may also be usefully in detecting candidates for surgical intervention.

DOI: Clin. Lab. 2012;58:145-151