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BackgroundThis study aimed to observe the role of urinary kidney injury molecule (KIM-1), interleukin (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP-7) levels in predicting acute kidney injury (AKI) in children with sepsis.Material and MethodsThis prospective cohort observational study was conducted at Dr. RSUP. Wahidin Sudirohusodo, Makassar, South Sulawesi, from January to December 2021. Inclusion criteria were septic patients treated in the pediatric intensive care unit (PICU) aged 1 month to 18 years with normal serum creatinine or normal urine output (>5 ml/kg/body weight (BW)/h in 6–12 h). Patients with a history of kidney disease, prior urinary tract infection, or history of using nephrotoxic drugs were excluded.ResultsThere was a significant difference in urinary KIM-1, IL-18, and IGFBP-7 levels between septic patients with and without AKI. The cut-off point for urinary KIM-1 level in sepsis with and without AKI was 1.666 ng/ml, with sensitivity of 82.5%, specificity of 82.2%, and a relative risk (RR) [95% confidence interval (CI)] of 6.866 (95% CI, 3.329–14.165). The cut-off point for urinary IL-18 levels was 3.868 ng/ml, with sensitivity of 92.50%, specificity of 91.78%, and RR of 20.078 (95%CI, 6.593–61.142). The cut-off point for urinary IGFBP-7 levels was ≥0.906 ng/ml with a sensitivity of 75.00%, specificity of 75.34%, and RR of 4.063 (95% CI, 2.206–7.483).ConclusionUrinary KIM-1, IL-8, and IGFBP-7 levels could be used to predict AKI in septic patients. Urinary IL-8 has a higher sensitivity and specificity as a predictor of AKI in patients with sepsis.

A cute Kidney Injury (AKI) merupakan komplikasi yang sering dan berat pada pasien sepsis di ICU. Terlebih lagi, terdapat bukti kuat antara sepsis dan syok sepsis sebagai penyebab AKI pada pasien sakit kritis. Terhitung, sekitar 50% atau lebih pasien di ICU akan terjadi AKI dengan angka mortalitas yang tinggi. Penelitian the beginning and ending supportive therapy (BEST), yang mengevaluasi 54 rumah sakit yang tersebar di 23 negara, menemukan bukti bahwa sepsis adalah penyebab AKI paling sering pada pasien sakit kritis (47,5%). Pada anak, angka kematian dengan sepsis menjadi >10 kali lipat apabila disertai acute renal failure.

OBJECTIVE: The study aimed to investigate the role of TNFα-308 genetic polymorphism, association between TNF-α serum level and prognostic factor of mortality in pediatric sepsis. METHODS: This was a prospective cohort study. Consecutive sampling method was used and samples were obtained from septic patients diagnosed based on the IPSC 2005 criteria. Serum TNF-α and genetic polymorphism were measuread and analyzed with ELISA and PCR plus sequencing, respectively. RESULT: One hundred and seventeen samples were included, 62 were in survivor grioup and 55 in non survivor group. A very significant association was found between TNF-α serum level and mortality (p<0.001). The optimal cut off point of TNFα serum level as prognostic factor for mortality was ≥ 500 pg/mL (p<0.001 and OR 16.6) sensitivity 78.1%, specificity 82%, Positive Predictive Value (PPV) 79.6%, Negative Predictive Value (NPV) 80.9%, Area Under Curve (AUC) 0.811. Two samples showed TNFα-308A polymorphism and mutation of GG allele to heterozygote GA allele. Neither TNFα polymorphism and TNFα serum level showed any association with mortality. There was no significant association between TNFα-308 polymorphism and TNF-α serum level p=0.461(p>0.05) and mortality p=0.219 (p>0.05), all sample who had TNFα-308 genetic polymorphism were in non survivor group and had TNF-α serum level ≥ 500 pg/mL. CONCLUSION: Genetic polymorphism of TNF-α-308 showed no statistic significant on mortality, but all subjects with TNFα-308 polymorphism had higher TNF-α serum and were all in non-survivor group.