title: The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations.
abstract: BACKGROUND
  Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE.
  
  
  METHODS
  A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high.
  
  
  RESULTS
  We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 vs 9.0 x 10(9)/l, P = 0.001) and urinary protein excretion (2.51 vs 1.68 g/day, P = 0.017), as well as a lower minimum blood platelet count (55 vs 80 x 10(9)/l, P < 0.001), hematocrit (0.34 vs 0.38, P = 0.001), and urinary output (1040 vs 2180 ml/day, P < 0.001). They also stayed longer in hospital than patients with low IL-6 (8 vs 6 days, P < 0.001). In contrast, high CRP did not associate with severe disease.
  
  
  CONCLUSIONS
  High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, POBox 2000, Tampere, FI-33521, Finland. Tuula.Outinen@uta.fi
authors.forename: Tuula K
authors.initials: TK
authors.lastname: Outinen
authors.forename: Satu M
authors.initials: SM
authors.lastname: Mäkelä
authors.forename: Ilpo O
authors.initials: IO
authors.lastname: Ala-Houhala
authors.forename: Heini Sa
authors.initials: HS
authors.lastname: Huhtala
authors.forename: Mikko
authors.initials: M
authors.lastname: Hurme
authors.forename: Antti S
authors.initials: AS
authors.lastname: Paakkala
authors.forename: Ilkka H
authors.initials: IH
authors.lastname: Pörsti
authors.forename: Jaana T
authors.initials: JT
authors.lastname: Syrjänen
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Mustonen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis*; D003404:Creatinine / Q000097:blood; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000473:pathology* / Q000821:virology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D011446:Prospective Studies; D011507:Proteinuria; D029262:Puumala virus / Q000302:isolation & purification*; D012720:Severity of Illness Index; D014556:Urine / Q000737:chemistry; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein; D003404:Creatinine