The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations

Abstract

BackgroundNephropathia 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.MethodsA 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.ResultsWe 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 × 109/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 × 109/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.ConclusionsHigh 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.

Determination of Procalcitonin Levels in Patients with Nephropathia Epidemica - A Useful Tool or an Unnecessary Diagnostic Procedure?

“…pituitary gland or within the gastrointestinal tract or pulmonary involvement. Several studies have sought to identify risk factors for severe disease at the time of diagnosis, but many of the variables investigated are not easily established in everyday clinical practice [11,14,18]. In this study, we investigated whether the routine parameter of PCT might be a useful predictive marker for a severe course of NE.…”

“…It is therefore important to identify parameters that allow individual risk stratification at the time of diagnosis. Several studies have sought to identify risk factors for a severe course of the disease, but most variables investigated are not easily measured in everyday clinical practice [11,14,18]. Therefore, a more practical approach is needed.…”

“…NE is characterized by acute kidney injury (AKI) with thrombocytopenia [9]. Additionally, signs and symptoms of systemic inflammation with fever, leukocytosis, and elevated C-reactive protein (CRP) levels are a common finding in patients with acute hantavirus infection [10,11,12,13,14]. Interleukin-10 and tumor necrosis factor (TNF)-alpha are both increased in patients with a severe course of PUUV and Dobrava infection.…”

Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

“…Complement activation, and several biomarkers including plasma interleukin (IL)-6, indoleamine 2,3-dioxygenase, pentraxin-3, soluble urokinase-type plasminogen activator receptor (suPAR), and urine GATA-3, are associated with the severity of AKI. However, plasma C-reactive protein (CRP) concentration is not associated with the severity of AKI, and it may even be a protective factor for kidney function [25,26,27,28,29,30]. Furthermore, urinary IL-6 and suPAR excretion correlate with proteinuria, which possibly reflects the local production of these molecules in the kidney [31,32].…”

A pauci-symptomatic case of documented Hantavirus (Puumala) infection in a patient under anti-TNF treatment

“…[11][12][13][14] On the other hand, it has been shown that TNF-␣ decreases the accumulation of viral nucleoproteins in Vero E6 cells infected with Sin Nombre virus. 15 Accordingly, hantavirus nucleocapsid proteins antagonize the signaling pathway of TNF-␣, suggesting that this cytokine may play a role in the immune response against hantavirus.…”