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. 2025 Sep 26;25(1):1142.
doi: 10.1186/s12879-025-11528-8.

Inflammatory parameters in the prediction of sepsis-induced acute kidney injury: a case-control study

Dajana Lendak  1   2 , Dunja Bečejac  3 , Sonja Mitić  3 , Sonja Adamović  3 , Katarina Samardžić  4 , Maria Pete  3   5 , Vedrana Petrić  3   5 , Gordana Jovanović  6   7 , Siniša Sević  3   5 , Nadica Kovačević  3   5
Affiliations

Inflammatory parameters in the prediction of sepsis-induced acute kidney injury: a case-control study

Dajana Lendak et al. BMC Infect Dis. .

Abstract

Background: Although hypovolemia was long considered the main cause of sepsis-induced acute kidney injury (SI-AKI), current theories explore multifactorial causes of injury (inflammation, immune response, ischaemia-reperfusion system and hypovolemia). The aim of this study was to determine the significance of inflammatory parameters (leucocyte, neutrophil, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT)) and mean-arterial pressure (MAP)) in prediction of SI-AKI development.

Methods: A total of 257 septic patients (Sepsis-3 criteria) were included. Patients were divided into two groups based on SI-AKI development (with SI-AKI, n = 133; without SI-AKI, n = 124). All patients had complete blood count with leukocyte formula, CRP, PCT, SOFA and qSOFA score available. Statistical analysis included non-parametric Mann-Whitney test, Spearman's correlations, ROC curve analysis, as well as binary logistic regression in order to identify independent predictors of SI-AKI.

Results: CRP (p < 0.001), PCT (p < 0.001) and NLR (p = 0.002) were higher in the SI-AKI group, and showed a significant correlation with creatinine levels (p < 0.001). MAP was significantly lower in the SI-AKI group (p = 0.043). Binary logistic regression analysis showed that CRP and PCT were only independent predictors of SI-AKI, along with SOFA score. ROC curve analysis showed that CRP ≥ 199 mg/L, and PCT ≥ 13ng/L represent the cut-off values for SI-AKI prediction.

Conclusions: Obtained results highlight the potential role of the inflammatory response in SI-AKI development.

Keywords: Acute renal injury; C-reactive protein; Neutrophil to lymphocyte ratio; Procalcitonin; Sepsis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the institutional review board of the Clinical Center of Vojvodina, Novi Sad, Serbia (No 00–20/126), and was conducted in accordance with the Declaration of Helsinki (ethical principles for medical research involving human participants). Informed consent was waived by institutional review board of the Clinical Center of Vojvodina, Novi Sad, Serbia (No 00–20/126) due to retrospective character of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flowchart
Fig. 2
Fig. 2
ROC curve analysis comparing the prognostic values of PCT, CRP and NLR for prediction of SI-AKI (a), ROC curve analysis for MAP prediction of SI-AKI (b) Abbreviations: PCT- procalcitonin; CRP- C-reactive protein; NLR- neutrophil-to-lymphocyte ratio; MAP- mean arterial pressure; ROC – Receiver operating curve; AUC – area under the curve
Fig. 3
Fig. 3
Correlation of inflammatory parameters and MAP with creatinine concentrations
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard G, Chiche J-D, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GC, Opal SM, Rubenfeld GD, Poll T, Van Der, Vincent J-L, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10. - PMC - PubMed
    1. Jacob JA. New sepsis diagnostic guidelines shift focus to organ dysfunction. JAMA. 2016;315:739–40. - PubMed
    1. Umbro I, Gentile G, Tinti F, Muiesan P, Mitterhofer AP. Recent advances in pathophysiology and biomarkers of sepsis-induced acute kidney injury. J Infect. 2016;72(2):131–42. 10.1016/j.jinf.2015.11.008. - PubMed
    1. Mårtensson J, Bellomo R. Sepsis-induced acute kidney injury. Crit Care Clin. 2015;31:649–60. 10.1016/j.ccc.2015.06.003. - PubMed
    1. Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J, Antunes F, Prata MM. Acute kidney injury in patients with sepsis: a contemporary analysis. Int J Infect Disease. 2009;13(2):176–81. - PubMed