Value of combined serum cathepsin S and urinary kidney injury molecule 1 in predicting acute kidney injury in children with type 1 diabetes mellitus and diabetic ketoacidosis
Abstract
ObjectiveTo address the clinical gap in predicting acute kidney injury （AKI） in children with type 1 diabetes mellitus （T1DM） complicated by diabetic ketoacidosis （DKA）， and to systematically investigate the predictive value of serum cathepsin S （CTSS） and urinary kidney injury molecule 1 （KIM-1） using least absolute shrinkage and selection operator （LASSO）-logistic regression and random forest algorithms， thereby providing a basis for early identification of high-risk children in clinical practice.MethodsA retrospective study included 106 children aged 5-14 years with T1DM complicated by DKA who were admitted to Tianjin Children’s Hospital （Children's Hospital， Tianjin University） from January 2022 to January 2024. According to Kidney Disease： Improving Global Outcomes criteria， the patients were divided into an AKI group （27 cases） and a non-AKI group （79 cases）. General clinical data and laboratory indicators were collected. Serum CTSS and urinary KIM-1 levels were measured using enzyme-linked immunosorbent assay. LASSO regression was used for variable selection， and Logistic regression was applied to identify independent influencing factors. A random forest algorithm was used to construct the prediction model. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of serum CTSS and urinary KIM-1 for AKI in children with T1DM complicated by DKA.ResultsCompared with the non-AKI group， the AKI group had higher levels of albumin （［46.16±5.95］ g/L vs ［41.97±5.41］ g/L）， blood glucose （［33.29±8.06］ mmol/L vs ［26.27±7.31］ mmol/L）， uric acid （462.94 ［380.35， 556.11］ μmol/L vs 305.28 ［245.85， 396.21］ μmol/L）， serum creatinine （73.62 ［68.25， 80.34］ μmol/L vs 41.18 ［37.38， 45.92］ μmol/L）， blood urea nitrogen （9.32 ［6.83， 12.52］ mmol/L vs 4.82 ［3.41， 5.87］ mmol/L）， corrected serum sodium （［140.56±5.67］ mmol/L vs ［135.84±5.49］ mmol/L）， and hematocrit （［43.05±4.85］% vs ［36.97±4.28］%）， with statistically significant differences （P<0.05）. Serum CTSS （1643.42 ［740.28， 1888.60］ ng/L vs 461.57 ［379.09， 569.24］ ng/L） and urinary KIM-1 （862.65 ［760.72， 1005.95］ ng/L vs 397.52 ［342.52， 463.98］ ng/L） were also significantly higher in the AKI group than in the non-AKI group （P<0.05）. Multivariable Logistic regression showed that uric acid （OR=1.019， 95%CI： 1.002-1.036）， hematocrit （OR=1.419， 95%CI： 1.026-1.964）， CTSS （OR=1.003， 95%CI： 1.000-1.005）， and urinary KIM-1 （OR=1.009， 95%CI： 1.002-1.016） were independent factors associated with AKI in children with T1DM complicated by DKA （all P<0.05）. In the random forest model， the importance of variables in descending order of predictive contribution was urinary KIM-1， hematocrit， uric acid， CTSS， blood glucose， corrected serum sodium， and albumin. ROC analysis showed that both CTSS ［area under the curve （AUC）=0.849］ and urinary KIM-1 （AUC=0.850） had good predictive value， and their combined prediction of AKI in children with T1DM complicated by DKA improved the AUC to 0.939 （both P<0.05）.ConclusionSerum CTSS and urinary KIM-1 can serve as effective predictive indicators for AKI in children with T1DM complicated by DKA， and their combined use can significantly improve predictive accuracy， providing a reference for early clinical intervention.
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BibTeX
@article{ying2026value,
title = {{Value of combined serum cathepsin S and urinary kidney injury molecule 1 in predicting acute kidney injury in children with type 1 diabetes mellitus and diabetic ketoacidosis}},
author = {Qian Ying and Zhang Ming-ying and Gao Long},
journal = {Linchuang shenzangbing zazhi},
year = {2026},
month = oct,
url = {http://www.lcszb.com/thesisDetails#10.3969/j.issn.1671-2390.2026.10.003},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Value of combined serum cathepsin S and urinary kidney injury molecule 1 in predicting acute kidney injury in children with type 1 diabetes mellitus and diabetic ketoacidosis
AU - Qian Ying
AU - Zhang Ming-ying
AU - Gao Long
PY - 2026
DA - 2026/10/24
JO - Linchuang shenzangbing zazhi
UR - http://www.lcszb.com/thesisDetails#10.3969/j.issn.1671-2390.2026.10.003
AB - ObjectiveTo address the clinical gap in predicting acute kidney injury （AKI） in children with type 1 diabetes mellitus （T1DM） complicated by diabetic ketoacidosis （DKA）， and to systematically investigate the predictive value of serum cathepsin S （CTSS） and urinary kidney injury molecule 1 （KIM-1） using least absolute shrinkage and selection operator （LASSO）-logistic regression and random forest algorithms， thereby providing a basis for early identification of high-risk children in clinical practice.MethodsA retrospective study included 106 children aged 5-14 years with T1DM complicated by DKA who were admitted to Tianjin Children’s Hospital （Children's Hospital， Tianjin University） from January 2022 to January 2024. According to Kidney Disease： Improving Global Outcomes criteria， the patients were divided into an AKI group （27 cases） and a non-AKI group （79 cases）. General clinical data and laboratory indicators were collected. Serum CTSS and urinary KIM-1 levels were measured using enzyme-linked immunosorbent assay. LASSO regression was used for variable selection， and Logistic regression was applied to identify independent influencing factors. A random forest algorithm was used to construct the prediction model. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of serum CTSS and urinary KIM-1 for AKI in children with T1DM complicated by DKA.ResultsCompared with the non-AKI group， the AKI group had higher levels of albumin （［46.16±5.95］ g/L vs ［41.97±5.41］ g/L）， blood glucose （［33.29±8.06］ mmol/L vs ［26.27±7.31］ mmol/L）， uric acid （462.94 ［380.35， 556.11］ μmol/L vs 305.28 ［245.85， 396.21］ μmol/L）， serum creatinine （73.62 ［68.25， 80.34］ μmol/L vs 41.18 ［37.38， 45.92］ μmol/L）， blood urea nitrogen （9.32 ［6.83， 12.52］ mmol/L vs 4.82 ［3.41， 5.87］ mmol/L）， corrected serum sodium （［140.56±5.67］ mmol/L vs ［135.84±5.49］ mmol/L）， and hematocrit （［43.05±4.85］% vs ［36.97±4.28］%）， with statistically significant differences （P<0.05）. Serum CTSS （1643.42 ［740.28， 1888.60］ ng/L vs 461.57 ［379.09， 569.24］ ng/L） and urinary KIM-1 （862.65 ［760.72， 1005.95］ ng/L vs 397.52 ［342.52， 463.98］ ng/L） were also significantly higher in the AKI group than in the non-AKI group （P<0.05）. Multivariable Logistic regression showed that uric acid （OR=1.019， 95%CI： 1.002-1.036）， hematocrit （OR=1.419， 95%CI： 1.026-1.964）， CTSS （OR=1.003， 95%CI： 1.000-1.005）， and urinary KIM-1 （OR=1.009， 95%CI： 1.002-1.016） were independent factors associated with AKI in children with T1DM complicated by DKA （all P<0.05）. In the random forest model， the importance of variables in descending order of predictive contribution was urinary KIM-1， hematocrit， uric acid， CTSS， blood glucose， corrected serum sodium， and albumin. ROC analysis showed that both CTSS ［area under the curve （AUC）=0.849］ and urinary KIM-1 （AUC=0.850） had good predictive value， and their combined prediction of AKI in children with T1DM complicated by DKA improved the AUC to 0.939 （both P<0.05）.ConclusionSerum CTSS and urinary KIM-1 can serve as effective predictive indicators for AKI in children with T1DM complicated by DKA， and their combined use can significantly improve predictive accuracy， providing a reference for early clinical intervention.
SN - 1671-2390
ER -