Chapter 10 - Biomarkers for the Diagnosis and Evaluation in Acute Encephalopathy

Abstract

Acute encephalopathy due to cytokine storm has markedly elevated proinflammatory cytokines in the serum. Children with hypercytokinemia often have systemic inflammatory response syndrome (SIRS). These findings are useful for diagnosing the type of the acute encephalopathy. Hyperglycemia, the presence of hematuria or proteinuria, and serum elevated levels of aspartate aminotransferase, tumor necrosis factor-α (TNF-α), cytochrome c, interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1), IL-10, tissue inhibitors of metalloproteinases 1 (TIMP-1), soluble CD163, and high mobility group box 1 (HMGB1) have been reported as markers indicating poor outcome of the type of the acute encephalopathy. It is often hard to distinguish acute encephalopathy due to excitotoxicity from prolonged febrile seizures without neurological sequelae during the initial stage. The CSF tau protein, S100B, visinin-like protein-1 (VILIP-1), and IL-6 have been reported as biomarkers for diagnosing the type of the acute encephalopathy at the initial stage. The serum elevated matrix metalloproteinase-9 (MMP-9) levels and MMP-9/TIMP-1 ratios have been reported as markers indicating poor outcome of the type of the acute encephalopathy.