Open Access Open Badges Research article

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

Tuula K Outinen1*, Satu M Mäkelä12, Ilpo O Ala-Houhala12, Heini SA Huhtala3, Mikko Hurme2, Antti S Paakkala4, Ilkka H Pörsti12, Jaana T Syrjänen12 and Jukka T Mustonen12

Author Affiliations

1 Department of Internal Medicine, Tampere University Hospital, P.O.Box 2000, Tampere, FI-33521, Finland

2 Medical School, University of Tampere, Tampere, FI-33014, Finland

3 Tampere School of Public Health, University of Tampere, Tampere, FI-33014, Finland

4 Department of Radiology, Tampere University Hospital, P.O. Box 2000, Tampere, FI-33521, Finland

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BMC Infectious Diseases 2010, 10:132  doi:10.1186/1471-2334-10-132

Published: 25 May 2010



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.


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.


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 × 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.


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.