ArticlePediatric research2026
Systemic immune-inflammation index (SII): a predictor of mortality risk in pediatric acute kidney injury.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInflammation is central to acute kidney injury (AKI) pathogenesis. The systemic immune-inflammation index (SII), a novel marker of immune-inflammatory balance, has been shown to predict outcomes in adult critically ill AKI patients, with limited pediatric evidence. This study aimed to assess the prognostic value of SII for mortality in critically ill children with AKI.
methodsThis single-center study included 619 PICU AKI patients (January 2019-June 2023,KDIGO criteria). Patients were categorized into survivors (n = 450) and non-survivors (n = 169), with demographic and clinical differences compared. SII was calculated using initial blood counts within 24 hours of PICU admission. Analyses included restricted cubic splines (RCS), logistic regression, and Kaplan-Meier curves.
resultsNon-survivors had lower SII (P < 0.001). RCS revealed a threshold-dependent non-linear SII-mortality association (P < 0.001): mortality positively linked to SII < 470.95 × 10⁹/L (low group) and negatively to 470.95 ≤ SII < 1019.99 × 10⁹/L (middle group). After adjusting for confounders, the low group had higher mortality risk vs. the middle group (AOR = 2.531, 95% CI = 2.011-6.013, P = 0.008).
conclusionsIn critically ill children with AKI, SII exhibited a threshold-dependent non-linear association with mortality, where lower SII levels were independently associated with an increased risk of mortality. IMPACT STATEMENT: In adult acute kidney injury (AKI) patients, both low and high systemic immune-inflammation index (SII) levels are significantly associated with increased in-hospital and intensive care unit (ICU) mortality. However, the association between SII and pediatric intensive care unit (PICU) mortality in pediatric AKI patients remains unclear. This study found a non-linear association between SII and mortality in critically ill children with AKI, where lower SII levels were independently associated with an increased risk of mortality. SII may be an early marker for predicting PICU mortality in critically ill children with AKI.
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