Abstract
Background
To determine the associations of urinary CXC motif chemokine 10 (uCXCL10) with AKI, sepsis and pediatric intensive care unit (PICU) mortality in critically ill children, as well as its predictive value for the aforementioned issues.
Methods
Urinary CXCL10 levels were serially measured in 342 critically ill children during the first week after PICU admission. AKI diagnosis was based on the criteria of KDIGO. Sepsis was diagnosed according to the surviving sepsis campaign’s international guidelines for children.
Results
Fifty-two (15.2%) children developed AKI, 132 (38.6%) were diagnosed with sepsis, and 30 (12.3%) died during the PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI, sepsis, septic AKI and PICU mortality. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI and PICU mortality were 0.63 (0.53–0.72), 0.62 (0.56–0.68), 0.75 (0.64–0.87) and 0.77 (0.68–0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56–0.75), sepsis 0.63 (0.57–0.69), septic AKI 0.76 (0.65–0.87) and PICU mortality 0.84 (0.76–0.91).
Conclusions
Urinary CXCL10 is independently associated with AKI and sepsis and may be a potential indicator of septic AKI and PICU mortality in critically ill children.
Impact
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Urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. AKI biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, especially in heterogeneous population.
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This study revealed that uCXCL10 levels are independently associated with increased risk for AKI, sepsis, septic AKI and PICU mortality.
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A higher uCXCL10 may be predictive of septic AKI and PICU mortality in critically ill children.
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Acknowledgements
We thank the staff in biochemistry laboratory for technical assistance.
Funding
This work was supported by grants from the National Natural Science Foundation of China (81971432), Jiangsu Province Science and Technology Support Program (BE2020660), Natural Science Foundation of Jiangsu Province (BK20171217), Key Talent of Women’s and Children’s Health of Jiangsu Province (FRC201738). The funders had no role in study design, data collection, preparation of the manuscript, and decision to publish.
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H.H. performed the experiments and data analysis and drafted the manuscript. H.Z. participated in data analysis and revised the manuscript. W.W., J.C., and Z.B. had primary responsibility for diagnosis of sepsis and participated in clinical data collection. X.D. and W.L. participated in collecting the data and samples. J.P. and X.L. participated in data analysis and interpretation. J.W. participated in the design of the study and coordination. Y.L. had primary responsibility for study design, performing the experiments, data analysis, interpretation of data, and writing the manuscript. All authors read and approved the final manuscript.
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The study was approved by the Institutional Review Board of the Children’s Hospital of Soochow university, and parental written informed consent was obtained for all participants.
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Huang, H., Zhou, H., Wang, W. et al. Prediction of acute kidney injury, sepsis and mortality in children with urinary CXCL10. Pediatr Res 92, 541–548 (2022). https://doi.org/10.1038/s41390-021-01813-y
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DOI: https://doi.org/10.1038/s41390-021-01813-y
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