Frontiers in nephrology · 2026
Renal resistive index and neonatal sequential organ failure assessment score as acute kidney injury risk predictors in preterm neonates with late-onset neonatal sepsis.
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Sitompul Abed Ricky H, Yuniati Tetty, Kadi Fiva Aprilia, Primadi Aris, Prasetyo Dwi, Widiasta Ahmedz, Haksari Ekawati L, Nugraha Harry G, Adibrata Antony A
Аннотация
AIM: Neonatal acute kidney injury (AKI) is an independent predictor of mortality with serum creatinine (sCr) remaining the gold standard. However, by the time sCr increases, the kidney may already have lost part of its function. Late-onset neonatal sepsis (LONS) is a common trigger of AKI through inflammation and renal hypoperfusion. The renal resistive index (RRI) is a Doppler-derived marker of renal perfusion, and the neonatal sequential organ failure assessment (nSOFA) score reflects systemic organ dysfunction that may accompany sepsis-associated AKI. This study aimed to compare the diagnostic performance of the RRI and nSOFA scores for predicting AKI risk in preterm neonates with probable LONS, using the STARZ (Sethi Tibrewal Agarwal Raina waZir) score for risk stratification.
METHODS: This is a single-center prospective study that observed all neonates admitted to the neonatal intensive care unit (NICU) with probable LONS from July to August 2025 defined using the sepsis prediction score. Clinical and laboratory data included the STARZ score, RRI, and the nSOFA score, which were obtained at birth and a few times after the diagnosis of probable LONS based on the sepsis prediction score.
RESULTS: A total of 36 preterm neonates were included. Median RRI and STARZ scores increased during the course of LONS, while nSOFA scores significantly differed between high- and low-risk AKI groups on multiple time points. Birth weight <1, 357 g and congenital heart disease were significant risk factors. Receiver operating characteristic (ROC) analysis showed birth weight <1, 357 g [area under the curve (AUC), 0.708; sensitivity, 72.22%; and specificity, 77.78% (p = 0.026)] and nSOFA score >3 on day 7 [AUC, 0.724; sensitivity, 61.11%; and specificity, 77.78% (p = 0.01)]. Multivariate analysis confirmed nSOFA score >3 on day 7 as a strong independent predictor of high-risk AKI [odds ratio (OR), 10.01; 95% confidence interval (CI), 1.18-85.13].
CONCLUSIONS: Serial nSOFA monitoring in preterm neonates with LONS may provide practical and accessible risk stratification for AKI and could support earlier identification of infants at high risk.
METHODS: This is a single-center prospective study that observed all neonates admitted to the neonatal intensive care unit (NICU) with probable LONS from July to August 2025 defined using the sepsis prediction score. Clinical and laboratory data included the STARZ score, RRI, and the nSOFA score, which were obtained at birth and a few times after the diagnosis of probable LONS based on the sepsis prediction score.
RESULTS: A total of 36 preterm neonates were included. Median RRI and STARZ scores increased during the course of LONS, while nSOFA scores significantly differed between high- and low-risk AKI groups on multiple time points. Birth weight <1, 357 g and congenital heart disease were significant risk factors. Receiver operating characteristic (ROC) analysis showed birth weight <1, 357 g [area under the curve (AUC), 0.708; sensitivity, 72.22%; and specificity, 77.78% (p = 0.026)] and nSOFA score >3 on day 7 [AUC, 0.724; sensitivity, 61.11%; and specificity, 77.78% (p = 0.01)]. Multivariate analysis confirmed nSOFA score >3 on day 7 as a strong independent predictor of high-risk AKI [odds ratio (OR), 10.01; 95% confidence interval (CI), 1.18-85.13].
CONCLUSIONS: Serial nSOFA monitoring in preterm neonates with LONS may provide practical and accessible risk stratification for AKI and could support earlier identification of infants at high risk.