***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT No data on lipopolysaccharide-binding protein ( LBP ) in newborns with sepsis have been available up to now . We therefore determined levels of LBP and soluble CD14 ( sCD14 ) in plasma of healthy and septic neonates in order to evaluate their potential diagnostic role . The study included prospect ively collected patient sample s of two recently published studies on cytokine expression in neonatal sepsis . Twenty-nine septic patients were enrolled in the present analysis . Sample s — either cord blood  or  peripheral blood  — from patients admitted within the first 24 h of life for suspicion of sepsis and cord blood sample s of a control group of 40 healthy mature infants delivered spontaneously were analyzed . For seven patients of the septic group , a second sample collected between 24 and 48 h of life was available . Levels of sCD14 and LBP in plasma were determined by an enzyme immunoassay using recombinant CD14 and LBP as st and ards . LBP and sCD14 were correlated to cytokine plasma levels . In septic neonates , LBP ( median , 36.6 versus 7.8 μg/ml ; P < 0.001 ) and sCD14 ( median , 0.42 versus 0.28 μg/ml ; P < 0.001 ) levels were highly elevated when compared to those of healthy neonates and strongly correlated to granulocyte colony-stimulating factor ( G-CSF ) , interleukin-1β ( IL-1β ) , IL-6 , and IL-8 levels . LBP levels in septic neonates analyzed between 24 and 48 h of life even increased when compared to sample s obtained at or shortly after delivery ( median , 36.6 versus 60 μg/ml ; P = 0.038 ) . In summary , levels of LBP in plasma of neonates with early-onset sepsis are significantly elevated ; the elevated plasma levels seem to persist for more than 24 h , which could provide the clinician with a prolonged time period to identify the newborn with bacterial sepsis In a prospect i ve study , levels of interleukin-1 beta ( IL-1 beta ) , interleukin-6 ) ( IL-6 ) , and tumor necrosis factor ( TNF ) were measured in a blind fashion in cord blood plasma from 92 neonates by specific immunoassays , and were correlated with the clinical courses of the infants , including type of delivery and perinatal complications . Plasma IL-1 beta concentration was undetectable in infants born by normal vaginal delivery or elective cesarean section but was significantly increased in infants born after induced vaginal deliveries ( 142 + /- 68 pg/ml ) or urgent cesarean section ( 290 + /- 21 pg/ml ; both p less than 0.05 compared with normal deliveries ) . The IL-1 beta levels were elevated in infants with severe perinatal complications ( 282 + /- 116 pg/ml ; p less than 0.001 ) , whereas TNF and IL-6 levels were not related to these complications . Infants with isolated perinatal infectious complications had elevated levels of plasma IL-6 compared with those of sick neonates without infection ( p less than 0.001 ) . In contrast , TNF plasma levels and IL-1 beta production by cord blood leukocytes were decreased in infants with infectious complications alone ( both p less than 0.05 ) . These studies suggest that the levels of IL-1 beta , IL-6 , and TNF in the cord plasma relate differentially to clinical complications in the perinatal period The first objective of this article was to determine the diagnostic accuracy of tumor necrosis factor-alpha , interleukin-6 ( IL-6 ) , and interleukin-8 ( IL-8 ) in differentiating infected from noninfected neonates during the first 24 hours of suspected sepsis and to compare them to the currently used laboratory parameters : C-reactive protein ( CRP ) , immature-to-total neutrophil ratio , and leukocyte and platelet count . The secondary objective was to compare the cytokine levels in sub population s of neonates . Seventy-five premature and 30 term infants were enrolled .  Blood sample s for the " currently used laboratory tests " and the  cytokine levels  were obtained at the first suspicion of sepsis ( " 0-hour " ) and 18 to 30 hours later ( " 24-hours " ) . Patients were classified as septic ( 48 ) or nonseptic ( 57 ) . Thirty-two septic patients had positive blood cultures and 16 showed clinical signs of sepsis . Twenty septic patients had early-onset and 28 had late-onset sepsis . Sensitivity , specificity , and positive and negative predictive values ( PPV and NPV ) were calculated for each test . Receiver-operating characteristic curves were analyzed to determine the optimal thresholds . A combination of  CRP  > 10 pg/mL plus IL-6 > 18 pg/mL ( sensitivity = 89 % , specificity = 73 % , PPV = 70 % , NPV = 90 % ) was the best " 0-hour " test , and CRP ( sensitivity = 78 % , specificity = 94 % ) was the best " 24-hours " test . Lower IL-6 at 0-hour ( p = 0.018 ) and IL-8 at 24 hours ( p = 0.023 ) were detected among the patients infected with coagulase-negative staphylococci then with other bacteria . In conclusion , a combination of CRP +  IL-6  provided additional diagnostic accuracy for differentiation between septic and nonseptic patients during the first 24 hours of suspected sepsis BACKGROUND Neonatal sepsis is a common and life-threatening disorder , particularly among preterm infants . Early initiation of antibiotic therapy is frequently delayed because the first clinical signs of sepsis are non-specific and there are no reliable early laboratory indicators . We investigated the time course of expression and the prognostic power of the early inflammatory mediators interleukin-1 receptor antagonist ( IL-1ra ) , interleukin-6 ( IL-6 ) , and circulating intercellular adhesion molecule-1 ( cICAM-1 ) before clinical diagnosis of sepsis . METHODS In a prospect i ve multicentre study , we monitored 182 very-low-birthweight infants in six intensive-care units for occurrence of sepsis . During routine or clinical ly indicated blood sampling , an additional sample was collected for measurement of  IL-1ra , IL-6 , cICAM-1 , and C-reactive protein ( CRP ) .  Infants were grouped into those with proven sepsis , no infection , or unclassified . The mean study duration was 34 days . Whenever sepsis occurred , a study period of 10 days was defined : day 0 was the day of clinical diagnosis of sepsis ; days -4 to -1 were the 4 days before diagnosis ; days + 1 to + 5 were the 5 days after . We compared the concentrations of the immune mediators during the 10-day study period with group-specific baseline values from before day -4 . FINDINGS 101 infants were included in the analysis : 21 with proven sepsis , 20 with no infection , and 60 unclassified . We excluded 57 because of incomplete data sets and 24 who had early-onset sepsis .  IL-1ra and IL-6 increased significantly 2 days before diagnosis of sepsis ; maximum median increases within the study period were 15-fold for IL-1ra and 12-fold for IL-6 . The diagnostic sensitivities of IL-1ra , IL-6 , and CRP concentrations on day 0 of diagnosis were 93 % , 86 % , and 43 % , respectively ; corresponding values on day -1 were 64 % , 57 % , and 18 % . The specificities of IL-1ra , IL-6 , and CRP concentrations were 92 % , 83 % , and 93 % . cICAM-1 had a specificity of only 64 % . INTERPRETATION IL-1ra and IL-6 are superior to cICAM-1 and CRP as predictors of sepsis 1 or more days before clinical diagnosis . Ad-hoc measurement of these cytokines could allow earlier initiation of antibiotic therapy with corresponding improvement in outcome in very-low-birthweight infants with sepsis OBJECTIVE To evaluate plasma levels of  interleukin-6 ( IL-6 ) and soluble tumor necrosis factor receptors ( sTNF-R ) 55 and 75 in neonates as a contribution to the early diagnosis of infection . STUDY DESIGN We prospect ively measured IL-6 and sTNF-R 55 and sTNF-R 75 plasma levels in 157 newborn infants admitted to our regional neonatal center in a 3-month period and in cord blood of 131 newborn infants delivered in our obstetrics unit . C-reactive protein was sequentially determined after admission . Newborn infants were classified into four groups : group 0 , not infected ; group 1 , possibly infected ; group 2a , infected ( culture positive ) , and group 2b , probably infected ( culture negative ) . We looked for the optimal cutoff point of these parameters , using the receiver operating characteristics ( ROC ) curve . RESULTS IL-6 levels were significantly higher in group 2 ( n = 11 ; median level , 250 pg/ml ; range , 0 to 81,000 ) , group 2b ( n = 25 ; median level , 750 pg/ml ; range , 0 to 180,000 ) , and group 1 ( n = 35 ; median level , 160 pg/ml ; range 0 to 10,000 ) , in comparison with group 0 ( n = 217 ; median level , 0 pg/ml ; range , 0 to 3400 ) . A cutoff value of 100 pg/ml or greater obtained by the ROC method gives a sensitivity of 83.3 % and a specificity of 90.3 % . For inborn infants ( n = 220 ) sample d at birth , sensitivity is 100 % and specificity 92.3 % . This high sensitivity persists until the twelfth hour of life . The sTNF-R 55 levels are significantly higher in group 2a ( median , 12.0 ng/ml ; range , 3.2 to 24.4 ) . In group 2b ( median , 7.0 ng/ml ; range , 3.0 to 25.2 ) , and in group 1 ( median , 7.0 ng/ml ; range , 2.5 to 18.9 ) than in group 0 ( median , 3.9 ng/ml ; range , 1.5 to 15.0 ) , and with a cutoff value of 6 ng/ml , sensitivity is 75 % and specificity 69 % . The sTNF-R 75 levels are significantly higher in group 2a ( median , 17.0 ng/ml ; range , 7.2 to 48.8 ) . In group 2b ( median , 11.2 ng/ ml ; range , ( 2.0 to 31.3 ) , and in group 1 ( median , 10.6 ng/ml ; range , 2.0 to 33.0 ) ; than in group 0 ( median , 7.0 ng/ml ; range , 1 to 23.0 ) . With a cutoff value of 9 ng/ ml , sensitivity is 80 % and specificity 67 % . Sensitivity of C-reactive protein is low initially but improves with time . Combining IL-6 with C-reactive protein provides the possibility of identifying the majority of infected infants in the postnatal period . CONCLUSION A plasma IL-6 level of 100 pg/ml or greater , obtained before the twelfth hour of life , appears to be an ideal marker for detecting early-onset  neonatal infection with a high degree of sensitivity and specificity . After the twelfth hour , the combined determination of IL-6 and C-reactive protein  may be equally useful . The sTNF-R levels appear to be less useful in the early diagnosis of infection because of their smaller magnitude of variation Objective Late-onset sepsis is responsible for high morbidity and mortality in newborn infants in the world and in particular in developing countries . In this study , we evaluated whether clinical characteristics , laboratory parameters and measurements of serum interleukin-8 ( IL-8 ) are able to discriminate between late neonatal sepsis and normal baby . Methods This was a prospect i ve ( case-control ) study conducted between March 2007 and April 2008 , at the neonatal intensive care unit , Ghaem Hospital , Mashhad , Iran . The study comprised 93 neonates ≥72 hours of life . The infants were categorized in two groups based on the clinical presentation , and biochemical markers including complete blood count , C-reactive protein ( CRP ) and blood culture : 1 ) Control group including 42 infants with routine screening  and 2 ) Case group consisting of 38 infants with definitive infection ( positive blood and /or cerebrospinal fluid culture ) or clinical sepsis ( clinical and laboratory signs of infection without positive blood or CSF culture ) . Receiver-operating characteristic curves were used for the determination of thresholds for the infection group versus healthy neonate group . Findings Eighty infants were enrolled in this study . IL-8 and CRP decreased in order of definitive infection , clinical sepsis and healthy subjects respectively ( P<0.001 ) . Sensitivity , specificity , positive predictive value , negative predict 
    Output:
    
Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables .
IL-6 seems to be a valid marker for predicting NS .