Comprehensive statistical analysis of serum interleukin-6 and C-reactive protein for early diagnosis of severe acute pancreatitis: A systematic review and meta-analysis.

Abstract

Severe acute pancreatitis (SAP) is a life-threatening condition requiring early diagnosis for timely intervention. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that rises earlier in response to inflammation. C-reactive protein (CRP) is commonly used but has limited early diagnostic accuracy. This meta-analysis aims to head-to-head compare the diagnostic accuracy of IL-6 and CRP for early SAP diagnosis. We systematically searched PubMed, Cochrane Library, and Google Scholar databases for relevant studies published until June 2024. We included those observational studies that reported the sensitivity and specificity of IL-6 and CRP for early SAP diagnosis. We compared the predictive accuracy of IL-6 versus CRP using pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristics area under the curve (SROC AUC). Heterogeneity was assessed using I² statistic. Subgroup and meta-regression analyses were performed to address significant heterogeneity. Deeks' funnel plot was used to evaluate publication bias. Meta-analysis included 17 studies with 1517 patients diagnosed with AP, of which 496 had SAP. The pooled sensitivity, specificity, DOR, and SROC AUC of IL-6 were 86%, 81%, 25, and 0.90, respectively, while for CRP, they were 75%, 75%, 9, and 0.81, respectively. The comparative predictive accuracy of IL-6 versus CRP showed a significant difference in pooled sensitivity (<i>P</i> = 0.041) and SROC AUC (<i>P</i> < 0.001) but comparable specificity (<i>P</i> = 0.286) and DOR (<i>P</i> = 0.102). IL-6 shows greater diagnostic accuracy than CRP for early SAP diagnosis. IL-6 can be considered both an early diagnostic and follow-up biomarker for AP.