Cao LF, Xu QB, Yang L. Systemic immune indicators for predicting renal damage in newly diagnosed type 1 diabetic children. World J Diabetes 2025; 16(5): 104482 [DOI: 10.4239/wjd.v16.i5.104482]
Corresponding Author of This Article
Li Yang, Chief Physician, Professor, Department of Endocrinology, Jiangxi Provincial Children’s Hospital/The Affiliated Children’s Hospital of Nanchang Medical College, No. 1666 Diezihu Avenue, Honggutan District, Nanchang 330038, Jiangxi Province, China. yangli1@ncmc.edu.cn
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. May 15, 2025; 16(5): 104482 Published online May 15, 2025. doi: 10.4239/wjd.v16.i5.104482
Systemic immune indicators for predicting renal damage in newly diagnosed type 1 diabetic children
Lan-Fang Cao, Qing-Bo Xu, Li Yang
Lan-Fang Cao, Qing-Bo Xu, Li Yang, Department of Endocrinology, Jiangxi Provincial Children’s Hospital/The Affiliated Children’s Hospital of Nanchang Medical College, Nanchang 330038, Jiangxi Province, China
Co-first authors: Lan-Fang Cao and Qing-Bo Xu.
Author contributions: Cao LF designed and conducted the research study; Xu QB contributed to data analysis and visualization; Cao LF and Xu QB contributed equally as co-first authors; Yang L supervised the project and provided conceptual guidance; and all authors contributed to writing and revising the manuscript and approved the final version submitted.
Supported by Jiangxi Provincial Health Commission Science and Technology Plan, No. SKJP220212334.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and approved by the Jiangxi Children’s Hospital Ethics Committee (Ethics Approval No: JXSETYY-YXKY-20240117).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data in this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Yang, Chief Physician, Professor, Department of Endocrinology, Jiangxi Provincial Children’s Hospital/The Affiliated Children’s Hospital of Nanchang Medical College, No. 1666 Diezihu Avenue, Honggutan District, Nanchang 330038, Jiangxi Province, China. yangli1@ncmc.edu.cn
Received: December 24, 2024 Revised: February 5, 2025 Accepted: February 26, 2025 Published online: May 15, 2025 Processing time: 122 Days and 16.3 Hours
Abstract
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.
Core Tip: This study highlights the predictive value of systemic inflammatory markers - systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio - for early kidney damage in children with newly diagnosed type 1 diabetes mellitus. SII emerged as a significant independent predictor of renal injury, with a high specificity threshold. The combination of SII with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio further enhanced diagnostic accuracy. These simple, cost-effective markers provide valuable tools for early detection and intervention, paving the way for improved clinical strategies to prevent diabetic nephropathy in pediatric type 1 diabetes mellitus patients.
