tetano
Editor, Senior Moderator
Transl Pediatr
. 2025 Oct 31;14(10):2686-2696.
doi: 10.21037/tp-2025-480. Epub 2025 Oct 29. Interleukin-6, serum albumin levels, and acute kidney injury jointly predict in-hospital mortality in pediatric COVID-19 patients
Yang Chen[SUP] #[/SUP][SUP] 1 [/SUP], Yingtao Zhang[SUP] #[/SUP][SUP] 2 [/SUP], Xiaodan Liu[SUP] 1 [/SUP], Yongwen Huang[SUP] 3 [/SUP], Xuan Feng[SUP] 1 [/SUP], Huabing Li[SUP] 4 [/SUP], Zhili Guo[SUP] 5 [/SUP], Lixiang Wang[SUP] 6 [/SUP], Kequan Li[SUP] 7 [/SUP], Caixia Wang[SUP] 8 [/SUP], Xianwei Liu[SUP] 9 [/SUP], Xuemei Wang[SUP] 10 [/SUP], Sainan Sun[SUP] 11 [/SUP], Hua Pan[SUP] 1 [/SUP]
Affiliations
Background: Severe coronavirus disease 2019 (COVID-19) is less common in children; nevertheless, it carries a mortality risk. Accurate prognostic tools for early risk stratification are therefore essential. This study evaluated the predictive capacity of a combination of interleukin-6 (IL-6), serum albumin (ALB), and acute kidney injury (AKI) for in-hospital mortality in this patient group.
Methods: A multicenter retrospective cohort study was conducted on pediatric patients with COVID-19 Omicron variant infection hospitalized between December 2021 and January 2022. The patients were stratified into risk groups based on their IL-6 levels, ALB levels, and the presence of AKI. Logistic regression and Cox proportional hazard models were used to evaluate associations between these biomarkers and in-hospital mortality.
Results: A total of 119 children (70 males, 49 females) with severe COVID-19 were included in this study. No AKI cases were observed in survivors, whereas 47.1% (8/17) of nonsurvivors had AKI, a statistically significant difference (P<0.001). Univariate logistic regression and multivariate Cox regression analyses identified IL-6, ALB, and creatinine as significant predictors of inpatient mortality [IL-6, hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.001-1.004, P<0.001; ALB, HR: 0.839, 95% CI: 0.761-0.925, P<0.001; creatinine, HR: 1.010, 95% CI: 1.006-1.014, P<0.001]. Receiver operating characteristic (ROC) analysis confirmed IL-6 [cutoff: 83.4 pg/mL, area under the curve (AUC): 0.897, P<0.001] and creatinine (cutoff: 67.05 µmol/L, AUC: 0.885, P<0.001) as strong predictors of mortality. Kaplan-Meier survival analysis showed a significantly higher mortality rate in the high-risk group compared to the medium- and low-risk groups (P<0.001).
Conclusions: The combined assessment of IL-6, ALB, and AKI effectively predicts inpatient mortality in pediatric COVID-19 patients, enabling early identification of high-risk cases and supporting stratified clinical management.
Keywords: Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); albumin (ALB); interleukin-6 (IL-6); pediatrics.
. 2025 Oct 31;14(10):2686-2696.
doi: 10.21037/tp-2025-480. Epub 2025 Oct 29. Interleukin-6, serum albumin levels, and acute kidney injury jointly predict in-hospital mortality in pediatric COVID-19 patients
Yang Chen[SUP] #[/SUP][SUP] 1 [/SUP], Yingtao Zhang[SUP] #[/SUP][SUP] 2 [/SUP], Xiaodan Liu[SUP] 1 [/SUP], Yongwen Huang[SUP] 3 [/SUP], Xuan Feng[SUP] 1 [/SUP], Huabing Li[SUP] 4 [/SUP], Zhili Guo[SUP] 5 [/SUP], Lixiang Wang[SUP] 6 [/SUP], Kequan Li[SUP] 7 [/SUP], Caixia Wang[SUP] 8 [/SUP], Xianwei Liu[SUP] 9 [/SUP], Xuemei Wang[SUP] 10 [/SUP], Sainan Sun[SUP] 11 [/SUP], Hua Pan[SUP] 1 [/SUP]
Affiliations
- PMID: 41216449
- PMCID: PMC12597191
- DOI: 10.21037/tp-2025-480
Background: Severe coronavirus disease 2019 (COVID-19) is less common in children; nevertheless, it carries a mortality risk. Accurate prognostic tools for early risk stratification are therefore essential. This study evaluated the predictive capacity of a combination of interleukin-6 (IL-6), serum albumin (ALB), and acute kidney injury (AKI) for in-hospital mortality in this patient group.
Methods: A multicenter retrospective cohort study was conducted on pediatric patients with COVID-19 Omicron variant infection hospitalized between December 2021 and January 2022. The patients were stratified into risk groups based on their IL-6 levels, ALB levels, and the presence of AKI. Logistic regression and Cox proportional hazard models were used to evaluate associations between these biomarkers and in-hospital mortality.
Results: A total of 119 children (70 males, 49 females) with severe COVID-19 were included in this study. No AKI cases were observed in survivors, whereas 47.1% (8/17) of nonsurvivors had AKI, a statistically significant difference (P<0.001). Univariate logistic regression and multivariate Cox regression analyses identified IL-6, ALB, and creatinine as significant predictors of inpatient mortality [IL-6, hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.001-1.004, P<0.001; ALB, HR: 0.839, 95% CI: 0.761-0.925, P<0.001; creatinine, HR: 1.010, 95% CI: 1.006-1.014, P<0.001]. Receiver operating characteristic (ROC) analysis confirmed IL-6 [cutoff: 83.4 pg/mL, area under the curve (AUC): 0.897, P<0.001] and creatinine (cutoff: 67.05 µmol/L, AUC: 0.885, P<0.001) as strong predictors of mortality. Kaplan-Meier survival analysis showed a significantly higher mortality rate in the high-risk group compared to the medium- and low-risk groups (P<0.001).
Conclusions: The combined assessment of IL-6, ALB, and AKI effectively predicts inpatient mortality in pediatric COVID-19 patients, enabling early identification of high-risk cases and supporting stratified clinical management.
Keywords: Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); albumin (ALB); interleukin-6 (IL-6); pediatrics.