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.

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.