Systemic immune indicators for predicting renal damage in newly diagnosed type 1 diabetic children

doi:10.4239/wjd.v16.i5.104482

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May 15, 2025 (publication date) through Apr 25, 2025

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Diabetes. May 15, 2025; 16(5): 104482
Published online May 15, 2025. doi: 10.4239/wjd.v16.i5.104482

Table 1 Comparison of general information and biochemical indices among four groups

Indicator	NC group	NUA1b group	MUA1b group	CUA1b group	F/H/χ²	P value
Age, months	112 (106, 116)	119 (77, 150)	123 (79, 155)	131 (82, 145)	0.005	0.995
Family history	65 (30, 35)	50 (23, 27)	32 (15, 17)	20 (11, 9)	0.489	0.783
BMI, kg/m²	16.79 (15.01, 19.54)	16.40 (15.38, 18.95)	15.70 (14.75, 17.25)	17.15 (14.73, 19.65)	3.76	0.153
SBP, mmHg	104 ± 11	106 ± 13	108 ± 10	109 ± 15	0.473	0.625
DBP, mmHg	66 (59, 73)	64 (60, 72)	65 (60, 70)	67 (60, 78)	0.758	0.471
Blood urea, mmol/L	4.03 (3.45, 4.68)	4.39 (3.86, 5.88)	4.90 (4.08, 6.43)	5.20 (4.14, 7.97)^a	3.348	0.187
Blood creatinine, μmol/L	37 (34, 42)	35 (30, 45)	33 (26, 44)	41 (35, 48)^c	2.006	0.14
C-reactive protein, mg/L	4.1 (0.1, 5.7)	3.4 (0.0, 5.2)	2.4 (0.7, 4.4)	5.0 (2.3, 11.2)	1.002	0.059
ALT, U/L	29 (11, 37)	32 (24, 41)	36 (27, 51)	40 (22, 49)	0.177	0.838
AST, U/L	32 (20, 36)	31 (22, 46)	34 (26, 44)	41 (19, 53)	0.007	0.993
Total cholesterol, mmol/L	3.89 (3.34, 4.39)	4.31 (3.79, 5.08)^a	4.91 (4.50, 5.41)^a^,^b	5.68 (4.19, 6.65)^a^,^b	8.708	0.013
Triglycerides, mmol/L	0.91 (0.71, 1.30)	1.05 (0.72, 2.15)^a	1.70 (1.19, 2.91)^a^,^b	2.83 (1.86, 3.79)^a^,^b^,^c	20.631	< 0.001
HDL, mmol/L	1.35 (1.18, 1.53)	1.25 (1.07, 1.54)	1.23 (1.00, 1.47)	1.31 (1.06, 1.44)	0.244	0.784
LDL, mmol/L	2.06 (1.76, 2.51)	1.94 (1.60, 2.61)	2.98 (2.20, 3.50)^a^,^b	2.44 (2.00, 3.31)^b	6.593	0.002
C-peptide, nmol/L	0.80 (0.55, 1.10)	0.25 (0.09, 0.48)^a	0.24 (0.15, 0.29)^a	0.20 (0.12, 0.32)^a	76.498	< 0.001
Insulin, mU/L	13.50 (8.50, 19.75)	2.46 (1.05, 5.62)^a	2.05 (1.07, 3.63)^a	2.79 (0.85, 4.22)^a	100.35	< 0.001
eGFR, mL/minute/1.73 m²	194.36 ± 44.67	202.63 ± 74.54	207.92 ± 54.58	164.64 ± 33.71^a^,^b^,^c	3.376	0.038
UACR, mg/g	8 (4, 14)	6 (3, 17)	76 (46, 158)^a^,^b	565 (366, 820)^a^,^b^,^c	85.232	< 0.001
HbA1c, %	5.0 (4.7, 5.3)	9.9 (7.0, 13.2)^a	12.9 (11.4, 16.0)^a^,^b	14.8 (13.4, 15.3)^a^,^b	19.238	< 0.001
Systemic inflammation index, 10⁹/L	278 (188.89, 331.47)	366.76 (254.14, 458.30)^a	331.12 (202.53, 999.19)^a	1459.92 (1214.27, 2838.30)^a^,^b^,^c	37.354	< 0.001
Neutrophil-to-lymphocyte ratio	1.12 (0.69, 1.46)	1.42 (1.02, 1.95)^a	1.80 (1.17, 2.59)^a	5.54 (2.58, 9.55)^a^,^b^,^c	24.207	< 0.001
Platelet-to-lymphocyte ratio	83.17 (59.83, 105.49)	104.05 (79.23, 115.83)^a	113.51 (85.76, 149.95)^a	130.13 (118.99, 195.80)^a^,^b^,^c	20.53	< 0.001

^aP < 0.05, comparisons with the NC group.

^bP < 0.05, comparisons with the NUA1b group.

^cP < 0.05, comparisons with the MUA1b group.

BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin-to-creatinine ratio; HbA1c: Glycated hemoglobin.

Table 2 Correlation of systemic immune inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with various indicators

Indicator	SII, r	SII, P	NLR, r	NLR, P	PLR, r	PLR, P
Age, months	0.12	0.228	0.055	0.585	0.084	0.4
SBP, mmHg	0.121	0.226	0.145	0.147	0.093	0.35
DBP, mmHg	0.119	0.232	0.200^a	0.044	0.048	0.634
Blood urea, mmol/L	0.121	0.226	0.092	0.36	0.129	0.195
Blood creatinine, μmol/L	0.089	0.372	0.168	0.091	0.117	0.24
TC, mmol/L	0.135	0.177	0.104	0.297	0.268^b	0.006
TG, mmol/L	0.270^b	0.006	0.188	0.058	0.227^a	0.022
HDL, mmol/L	-0.091	0.362	0.092	0.358	0.154	0.123
LDL, mmol/L	0.111	0.266	0.056	0.573	0.177	0.075
HbA1c, %	0.200^a	0.044	0.129	0.197	0.176	0.077
eGFR, mL/minute/1.73 m²	-0.064	0.521	-0.183	0.066	-0.054	0.588
UACR, mg/g	0.552^b	< 0.001	0.413^b	< 0.001	0.300^b	< 0.001
ALT, U/L	-0.076	0.451	0.045	0.65	-0.064	0.522
AST, U/L	0.012	0.908	-0.067	0.501	0.13	0.194
BMI, kg/m²	-0.008	0.933	-0.003	0.973	-0.031	0.755
C-peptide, nmol/L	0.063	0.529	-0.151	0.129	-0.084	0.401
Insulin, mU/L	-0.052	0.604	-0.036	0.716	0.045	0.653
Family history	0.086	0.391	0.032	0.753	0.054	0.592
C-reactive protein, mg/L	0.151	0.131	0.034	0.738	0.063	0.529

^aP < 0.05.

^bP < 0.01.

“r” denotes the correlation coefficient. “P” denotes the P value. SII: Systemic immune inflammation index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; TC: Total cholesterol; TG: Triglycerides; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; HbA1c: Glycated hemoglobin; eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin-to-creatinine ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index.

Table 3 Predictive significance of biomarkers for early kidney damage in children with type 1 diabetes mellitus

Indicator combination	AUC	95% confidence interval	P value	Threshold	Sensitivity, %	Specificity, %
SII	0.72	0.612-0.826	< 0.001	624.015	59.6	92
NLR	0.7	0.603-0.804	< 0.001	2.17	55.8	80
PLR	0.71	0.604-0.811	< 0.001	127.51	53.8	94
SII + NLR	0.77	0.676-0.869	< 0.001	0.645	55.8	98
SII + PLR	0.79	0.695-0.887	< 0.001	0.502	69.2	90
NLR + PLR	0.73	0.627-0.828	< 0.001	0.466	63.5	84
SII + NLR + PLR	0.79	0.690-0.883	< 0.001	0.604	63.5	96

AUC: Area under the curve; SII: Systemic immune inflammation index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio.

Citation: 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
URL: https://www.wjgnet.com/1948-9358/full/v16/i5/104482.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i5.104482