Expression and Prognostic Value of Serum SAA, IL-6, TNF-α and microRNAs in Children with Sepsis Complicated with Acute Kidney Injury

Abstract

Background Acute kidney injury (AKI) is a common complication of sepsis. Immune-inflammatory markers are commonly used to assess the prognosis of these patients. However, studies evaluating microRNAs (miR) in this context are scarce, indicating a need for further clinical investigation. Objective To investigate the expression of serum amyloid A (SAA), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and miR in pediatric patients with sepsis-induced AKI and analyze their prognostic assessment value. Methods This study included 100 pediatric patients with sepsis-induced AKI admitted to the First People's Hospital of Pingdingshan from March 2020 to March 2023 as the observation group, and 80 pediatric patients with sepsis alone as the control group. General patient data were collected, and serum levels of SAA, IL-6, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). The relative expression of miR-21-3p, miR-182-5p, and miR-128-3p was quantified using real-time quantitative PCR. The Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ) score were compared between the groups. Pearson correlation analysis was used to evaluate the relationship between the levels of serum SAA, IL-6, TNF-α, and miRs and the SOFA and APACHEⅡ scores. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of these markers for mortality in pediatric patients with sepsis-induced AKI and to calculate the area under the ROC curve (AUC) . Results The observation group showed significantly higher SOFA scores, APACHE Ⅱ scores, and levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to the control group (P<0.05). After 28 days of hospitalization, 74 patients in the observation group survived, while 26 died. Surviving patients had lower levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to those who died (P<0.05). Levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p were positively correlated with SOFA and APACHEⅡ scores (P<0.05). ROC curve results showed a combined predictive AUC of 0.926 (95%CI=0.856-0.969, P<0.05) . Conclusion The serum levels of SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, miR-128-3p are abnormally high in children with sepsis complicated with AKI. Clinical detection of these indicators has a high value and early warning effect on the prognosis of children.

Keywords

• sepsis|acute kidney injury|serum amyloid a|interleukin-6|tumor necrosis factor alpha