Predictive value of serum interleukin-6 level in influenza virus–associated encephalopathy

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Abstract
Objective: In Japan, >200 children with influenza virus–associated encephalopathy were reported in 1999 and the mortality rate was high. The levels of tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6) in both CSF and serum were significantly increased in severe cases. The authors found a correlation between elevated serum cytokine levels and mortality and neurologic morbidity. Methods: TNFα, IL-6, soluble tumor necrosis factor receptor 1 (sTNF-R1), interferon-Îł (IFNÎł), and IL-2 were measured by the ELISA method in sera from six children with encephalopathy before and during therapy, and in six age-matched controls with influenza type A virus infection. Results: The increases in the serum TNFα, IL-6, and sTNF-R1 levels were statistically significant at the onset of symptoms before therapy, but the IL-6 level was most useful for diagnosis. The serum IL-6 levels were >6,000 pg/mL in children with brain stem dysfunction, about 150 pg/mL in children without brain stem dysfunction, and 15,000 pg/mL, none of the children survived. The lower the maximal serum IL-6 level, the milder the CNS sequelae. Conclusion: The serum IL-6 level may be the most useful indicator for the diagnosis and the clinical severity of influenza virus–associated encephalopathy.

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