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Systemic immune-inflammation index (SII): a predictor of mortality risk in pediatric acute kidney injury

Lian Feng1,2, Junlong Hu2, Jie Mao2

  • 1Department of Pediatrics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China.

Pediatric Research
|January 29, 2026
PubMed

Insights

Lower systemic immune-inflammation index (SII) levels predict higher mortality risk in critically ill children with acute kidney injury (AKI). This finding suggests SII may serve as an early prognostic marker for pediatric AKI patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Immunology

Background:

  • Inflammation is a key factor in acute kidney injury (AKI) pathogenesis.
  • The systemic immune-inflammation index (SII) is a novel marker of immune balance.
  • Limited pediatric data exists on SII's prognostic value in AKI.

Purpose of the Study:

  • To evaluate the prognostic significance of SII for mortality in critically ill children with AKI.
  • To investigate the association between SII levels and mortality outcomes in pediatric AKI patients.

Main Methods:

  • Single-center study of 619 pediatric intensive care unit (PICU) AKI patients (KDIGO criteria).
  • Categorization into survivors (n=450) and non-survivors (n=169).
  • SII calculated from initial blood counts; analyses included restricted cubic splines and logistic regression.

Main Results:

  • Non-survivors exhibited lower SII levels (P < 0.001).
  • A non-linear, threshold-dependent association was observed between SII and mortality (P < 0.001).
  • Lower SII (< 470.95 × 10⁹/L) was independently linked to increased mortality risk (AOR = 2.531, P = 0.008).

Conclusions:

  • SII demonstrates a non-linear association with mortality in critically ill pediatric AKI patients.
  • Lower SII levels are independently associated with an elevated risk of mortality.
  • SII may serve as an early predictive marker for PICU mortality in pediatric AKI.
Abstract

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