title: Changes in the interleukin-6/soluble interleukin-6 receptor axis in meningococcal septic shock.
abstract: OBJECTIVE
  Interleukin-6 is strongly associated with disease severity and outcome in meningococcal septicemia. It is known that interleukin-6 exerts many of its effects via the soluble interleukin-6 receptor. By facilitating the activity of interleukin-6, it is likely that alterations in the levels of soluble interleukin-6 receptor in septic shock could affect the severity of disease. We aimed to investigate changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcal septicemia and the relationship with disease severity.
  
  
  METHODS
  Laboratory investigation of interleukin-6 and soluble interleukin-6 receptor levels in children with meningococcal disease.
  
  
  METHODS
  University hospital and laboratories.
  
  
  METHODS
  Children with severe meningococcal disease requiring intensive care.
  
  
  METHODS
  Blood samples obtained on admission to the intensive care unit were analyzed for interleukin-6 and soluble interleukin-6 receptor levels. Levels were also serially measured for up to 48 hrs in a subset of patients.
  
  
  RESULTS
  Cytokine levels were measured by enzyme-linked immunosorbent assay using mouse monoclonal antihuman antibodies. Acute meningococcemia is associated with a reduction in soluble interleukin-6 receptor levels in proportion to disease severity and is inversely related to interleukin-6 levels. Soluble interleukin-6 receptor returns to levels seen in normal donors following recovery from meningococcal septicemia.
  
  
  CONCLUSIONS
  Changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcemia may affect the severity and progression of multiple organ failure. Interventions to modulate this axis may improve outcome from meningococcal septic shock.
authors.affiliation: Department of Paediatrics, Imperial College School of Medicine, St. Mary's Hospital, London, UK.
authors.forename: Nazima
authors.initials: N
authors.lastname: Pathan
authors.forename: E John
authors.initials: EJ
authors.lastname: Williams
authors.forename: E Emanuelle
authors.initials: EE
authors.lastname: Oragui
authors.forename: Alick C
authors.initials: AC
authors.lastname: Stephens
authors.forename: Michael
authors.initials: M
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000378:metabolism*; D008131:London / Q000453:epidemiology; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D019947:Receptors, Interleukin-6 / Q000378:metabolism*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000276:immunology* / Q000382:microbiology / Q000401:mortality
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D019947:Receptors, Interleukin-6