Predicting Acute Kidney Injury in Children with Sepsis Using Red Blood Cell Distribution and biomarkers (PCT, IL-6, CRP, and cystatin C)
biomarkers (PCT, IL-6, CRP, and cystatin C) in Predicting Acute Kidney Injury
Abstract
Introduction: This study aimed to develop a risk score model for predicting acute kidney injury (AKI) in children with sepsis, using red blood cell distribution width (RDW), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and additional biomarkers (PCT, IL-6, CRP, and cystatin C) based on logistic regression (LR) analysis.
Method: Children treated in the ICU of The First Affiliated Hospital of Xinjiang Medical University from July 2021 to August 2022 were enrolled. The experimental group (Exp) included 155 children with sepsis, while the control group (Ctrl) consisted of 70 children. LR analysis was employed to identify factors associated with AKI risk. The Exp was further divided into two subgroups: the routine group (RG, n=77) and the intervention group (IG, n=78). The IG received intervention based on the risk score model, while the RG received routine treatment. Receiver operating characteristic (ROC) curves were used for diagnostic evaluation.
Results: Significant differences were observed in white blood cell count (WBC) and RDW levels between the two groups. The development of AKI in sepsis patients was strongly associated with RDW, APACHE II score, and the biomarkers PCT, IL-6, CRP, and cystatin C. After the intervention, the incidence of AKI and AKI grade 3 significantly decreased, along with lower rates of renal replacement therapy and mortality. ROC analysis demonstrated that combining RDW and APACHE II score yielded the highest diagnostic accuracy for predicting AKI.
Conclusion: The LR-based model integrating RDW, APACHE II score, and biomarkers (PCT, IL-6, CRP, cystatin C) effectively predicts the risk of AKI in children with sepsis, offering a valuable tool for early intervention and improved patient outcomes.
References
2. An R, Feng JX, Xi C, Xu J, Sun LJ. miR-146a attenuates sepsis-induced myocardial dysfunction by suppressing IRAK1 and TRAF6 via targeting ErbB4 expression. Oxidative Medicine and Cellular Longevity, 2018;2018:7163057(1-9).
3. Wang YY, Xu D, Shen JL, Zhou QT, Zhao HJ, Chen YL, Wang MD. Effect of 1-methyltryptophan on lipopolysaccharide-induced permeability and apoptosis in human umbilical vein endothelial cells. Chinese Journal of Emergency Medicine, 2021;30(1):59-63.
4. Peng Y, Wang Q, Jin F, Tao T, Qin Q. Assessment of urine CCL2 as a potential diagnostic biomarker for acute kidney injury and septic acute kidney injury in intensive care unit patients. Renal Failure, 2024;46(1):2313171(1-9).
5. Liu HQ, Tian YH, Liu CL, Wang DW, Wang HJ. Effect of glutathione-assisted continuous renal replacement therapy in sepsis patients with acute renal injury. Clinical Nephrology, 2024;101(4):191-198.
6. Tan Y, Yu Z, Li P, Liu Y, You T, Kuang F, Luo W. Circ_0001714 knockdown alleviates lipopolysaccharide-induced apoptosis and inflammation in renal tubular epithelial cells via miR-129-5p/TRAF6 axis in septic acute kidney injury. Journal of Bioenergetics and Biomembranes, 2023;55(4):289-300.
7. Lai H, Wu G, Zhong Y, Chen G, Zhang W, Shi S, Xia Z. Red blood cell distribution width improves the prediction of 28-day mortality for patients with sepsis-induced acute kidney injury: a retrospective analysis from MIMIC-IV database using propensity score matching. Journal of Intensive Medicine, 2023;3(3):275-282.
8. Wei Z, Zhao L, Yan J, Wang X, Li Q, Ji Y, Liu J, Cui Y, Xie K. Dynamic monitoring of neutrophil/lymphocyte ratio, APACHE II score, and SOFA score predict prognosis and drug resistance in patients with acinetobacter baumannii-calcoaceticus complex bloodstream infection: a single-center retrospective study. Frontiers in Microbiology, 2024;15:1296059(1-13).
9. Lashin HI, Sharif AF. Evaluation of various scoring systems as predictors of the need for intensive care unit admission and other adverse outcomes among patients with acute clozapine poisoning. Toxicology Research, 2023;12(3):468-479.
10. Li W, Song Y. Red cell distribution width to albumin ratio is a risk factor for atrial fibrillation in subjects hospitalized with coronary angiography. BMC Cardiovascular Disorders, 2024;24(1):95(1-8).
11. Wang H, Xie D, Wang S, Wu L, Chu Y, Yang P, He W, Wang J. The value of preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and red blood cell distribution width in predicting positive surgical margin after laparoscopic radical prostatectomy. Cancer Reports (Hoboken, N. J.), 2024;7(2):e1977(1-11).
12. Zhang C, Hou T, Liang W, Hao C, Wang F, Xin J, Su B, Ning M, Liu Y. Prognostic value of red blood cell distribution width combined with chloride in predicting short- and long-term mortality in critically ill patients with congestive heart failure: Findings from the MIMIC-IV database. Heliyon, 2024;10(1):e23353(1-9).
13. Lu H, Xu Q, Zou G, Gao H, Yang Y, Li W, Zhuo L. Prevalence and immunopathologic characteristics of seropositive and seronegative hepatitis B virus-associated membranous nephropathy: a retrospective study of 420 biopsy-proven cases. Renal Failure, 2024,46(1):2313180(1-8).
14. Ling J, Yang X, Dong L, Jiang Y, Zou S, Hu N. Utility of cystatin C and serum creatinine-based glomerular filtration rate equations in predicting vancomycin clearance: a population pharmacokinetics analysis in elderly Chinese patients. Biopharmaceutics Drug Disposition, 2024,45(1):58-68.
15. Zhu B, Jia Z, Liu F, Chen Z. Diagnostic value of serum gasdermin family protein D-N terminal combined with APACHE II score for sepsis complicated with acute kidney injury. Modern Practical Medicine, 2023;35(10):1286-1289.
16. Zhang Y. Clinical study on predicting early acute kidney injury related to sepsis using lactate clearance rate combined with APACHE II score. Chinese Prescription Medicine, 2022;20(06):123-125.
17. Wang Y, Huang Y. Changes in urine NGAL, blood Cys C, and Scr in hypertensive acute kidney injury and their relationship with disease staging. Journal of Chinese and Foreign Medical Research, 2023;21(33):75-78.
18. Feng LM, Zhong RR. Diagnostic value of blood cysteine protease inhibitor C in predicting acute renal injury in premature infants. Journal of Fujian Medical University, 2022;56(02):143-147.
19. Wen F, Yu L, Xia C, Gu Z. Development and study of S100 calcium-binding protein B and Neuron-specific enolase-based predictive model for epilepsy secondary to cerebral infarction. Cellular and molecular Biology (Noisy-le-Grand, France), 2022;68(10):130-135.
20. Beminate LS, Kusse UM, Bruck TL, Tsion MT. Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis. BMJ Open, 2024;14(2):e073447(1-13).
21. Shi J, Zhang F, Fan W. The predictive value of acute gastrointestinal injury score combined with red blood cell distribution width and blood calcium ratio for the severity and prognosis of acute pancreatitis. Chinese Journal of Modern Medicine, 2023;25(12):33-36.
22. Wang G, Cao Y. Research progress on red blood cell distribution width and its derivatives as biomarkers of digestive system inflammation and tumor diseases. Journal of Nanjing Medical University (Natural Science Edition), 2023;43(12):1764-1770.
23. Wang Y, Sun L, Zhao H. The value of urine NGAL, KIM-1 combined with APACHE II score in predicting the prognosis of patients with sepsis complicated by acute kidney injury. Journal of Clinical Nephrology, 2019;19(05):322-325.
24. Xiong S. The effect of CVVH on APACHE II score and renal function in patients with severe hemorrhagic fever with renal syndrome. Grassroots Medical Forum, 2020;24(13):1920-1921.
25. Zou F, Tang X, Lei X, Cao F, Luo J, Liu S. Treatment efficacy of continuous renal replacement on symptoms, inflammatory mediators, and coagulation function in patients with sepsis-associated acute kidney injury. Archivos Espanoles De Urologia, 2022;75(9):746-752.
26. Shimoyama Y, Umegaki O, Kadono N, Minami T. Presepsin and platelet to lymphocyte ratio predict the progression of septic subclinical acute kidney injury to septic acute kidney injury: a pilot study. BMC Research Notes, 2022;15(1):212(1-6).
Copyright (c) 2025 SuBai NuEr
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.