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Systemic immune indicators for predicting renal damage in newly diagnosed type 1 diabetic children
Lan-Fang Cao1, Qing-Bo Xu1, Li Yang2
1Department of Endocrinology, Jiangxi Provincial Children's Hospital/The Affiliated Children's Hospital of Nanchang Medical College, Nanchang 330038, Jiangxi Province, China.
Insights
Systemic immune inflammation index (SII) effectively predicts early kidney damage in children with type 1 diabetes mellitus (T1DM). Combining SII with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) improves diagnostic accuracy for renal complications.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Inflammation Research
Background:
- Type 1 diabetes mellitus (T1DM) in children can lead to early kidney damage, a complication linked to systemic inflammation.
- Inflammatory markers like SII, NLR, and PLR are being explored as potential indicators of diabetic nephropathy.
Purpose of the Study:
- To assess the association between SII, NLR, PLR, and early kidney damage in newly diagnosed T1DM children.
- To evaluate the utility of these inflammatory markers as predictive biomarkers for diabetic nephropathy in pediatric T1DM.
Main Methods:
- A longitudinal cohort study involved 102 children (3-18 years) with newly diagnosed T1DM and no prior albuminuria.
- Participants were monitored for up to three years, with baseline and follow-up data including inflammatory markers and urinary albumin-to-creatinine ratio (UACR).
- Logistic regression and ROC analyses were employed to determine predictive values for early kidney damage (UACR ≥ 30 mg/g).
Main Results:
- SII was identified as a significant independent predictor of early kidney damage (P = 0.0016), with an AUC of 0.719.
- An SII threshold of ≥ 624.015 demonstrated 59.6% sensitivity and 92% specificity.
- Combining SII with NLR and PLR enhanced predictive accuracy (AUC = 0.787), achieving 63.5% sensitivity and 96% specificity.
Conclusions:
- SII is a reliable and highly specific biomarker for detecting early kidney damage in pediatric T1DM.
- Integrating SII, NLR, and PLR into clinical practice can improve diagnostic precision for renal complications.
- Longitudinal monitoring of these markers may enable timely interventions to prevent kidney disease progression in T1DM.
Background:
Early kidney damage is a significant complication in children with newly diagnosed type 1 diabetes mellitus (T1DM). Systemic inflammation plays a key role in the development of diabetic nephropathy. Several inflammatory markers, including the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been proposed as potential indicators of diabetic complications.
Aim:
To investigate the association between SII, NLR, PLR, and early kidney damage in newly diagnosed T1DM children without pre-existing albuminuria, assessing their utility as predictive biomarkers.
Methods:
A longitudinal cohort study was conducted on 102 children aged 3-18 years with newly diagnosed T1DM [baseline urinary albumin-to-creatinine ratio (UACR) < 30 mg/g] recruited between January 2020 and June 2023. Participants were followed biannually for up to three years. Demographic, clinical, and laboratory data, including inflammatory markers (SII, NLR, PLR), were collected at baseline and follow-up. Logistic regression and receiver operating characteristic analyses were used to evaluate the predictive utility of these markers for early kidney damage, defined as UACR ≥ 30 mg/g.
Results:
SII emerged as a significant independent predictor of early kidney damage [odds ratio = 1.002, 95% confidence interval (CI): 1.0008-1.0033, P = 0.0016], with an area under the curve of 0.719 (95%CI: 0.612-0.826, P < 0.001). Using an SII threshold of ≥ 624.015 achieved a sensitivity of 59.6% and specificity of 92%. Combining SII with NLR and PLR improved predictive accuracy (area under the curve = 0.787), with sensitivity and specificity of 63.5% and 96%, respectively. Correlation analyses revealed significant associations between SII, metabolic markers (triglycerides, glycated hemoglobin), and UACR.
Conclusion:
SII is a reliable biomarker for early kidney damage in T1DM children, offering high specificity for identifying at-risk patients. Combining SII with NLR and PLR enhances diagnostic precision, supporting its integration into clinical practice. Longitudinal monitoring of these markers may facilitate early interventions to mitigate renal complications in pediatric T1DM.
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