Infection and drug resistance · 2026
Baseline and 7-Day Dynamic Changes of T Helper 17/Regulatory T Cells Ratio and Their Association with Renal Recovery and Prognosis in Sepsis-Induced Acute Kidney Injury: An Exploratory Analysis.
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Zhou Xiao, Lin Jin, Duan Meili
Аннотация
OBJECTIVE: Sepsis-associated acute kidney injury (SAKI) is a serious complication with high mortality. This study aimed to investigate the relationship between T helper 17 (Th17)/regulatory T cells (Treg) immune imbalance and renal function recovery in patients with SAKI, with a novel focus on evaluating both baseline and early dynamic changes as exploratory biomarkers for renal recovery and overall prognosis.
METHODS: Sixty adult patients with SAKI admitted to the intensive care unit were enrolled and followed for 28 days. Based on renal recovery, patients were stratified into recovery and non-recovery groups, with further subgroup analysis. Clinical data and blood samples were collected serially.
RESULTS: Renal recovery occurred in 42 patients (70%). Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, a higher baseline Th17/Treg ratio (time zero [D0]) and a greater decrease in this ratio over 7 days (Δ7) demonstrated potential statistical correlations with non-recovery. The D0 ratio differentiated non-recovery with an area under the curve (AUC) of 0.804 (cut-off >0.31128), and the Δ7 ratio (reflecting early immune trajectories during the first week) with an AUC of 0.762 (cut-off <-0.2055). A low baseline ratio with a high Δ7 was associated with early, complete recovery. A D0 ratio >0.31128 or a Δ7 ratio <-0.2055 was retrospectively observed to correlate with significantly higher 28-day mortality (60.0% vs 40.0%, p<0.05). The discriminative efficacy of D0 and Δ7 Th17/Treg ratios was comparable to KDIGO staging for renal non-recovery in patients with SAKI.
CONCLUSION: Baseline and early dynamic Th17/Treg measures showed an observational trend with renal non-recovery in this single-centre prospective cohort of patients with SAKI. However, this study is limited by its small sample size and observational design. These exploratory findings, including the data-derived thresholds, require validation in larger cohorts with prespecified temporal analysis before clinical application.
METHODS: Sixty adult patients with SAKI admitted to the intensive care unit were enrolled and followed for 28 days. Based on renal recovery, patients were stratified into recovery and non-recovery groups, with further subgroup analysis. Clinical data and blood samples were collected serially.
RESULTS: Renal recovery occurred in 42 patients (70%). Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, a higher baseline Th17/Treg ratio (time zero [D0]) and a greater decrease in this ratio over 7 days (Δ7) demonstrated potential statistical correlations with non-recovery. The D0 ratio differentiated non-recovery with an area under the curve (AUC) of 0.804 (cut-off >0.31128), and the Δ7 ratio (reflecting early immune trajectories during the first week) with an AUC of 0.762 (cut-off <-0.2055). A low baseline ratio with a high Δ7 was associated with early, complete recovery. A D0 ratio >0.31128 or a Δ7 ratio <-0.2055 was retrospectively observed to correlate with significantly higher 28-day mortality (60.0% vs 40.0%, p<0.05). The discriminative efficacy of D0 and Δ7 Th17/Treg ratios was comparable to KDIGO staging for renal non-recovery in patients with SAKI.
CONCLUSION: Baseline and early dynamic Th17/Treg measures showed an observational trend with renal non-recovery in this single-centre prospective cohort of patients with SAKI. However, this study is limited by its small sample size and observational design. These exploratory findings, including the data-derived thresholds, require validation in larger cohorts with prespecified temporal analysis before clinical application.