Low Serum Alkaline Phosphatase Levels in Paediatric sepsis Correlate With Acute Kidney Injury: A Multicenter Retrospective Study
Evgenia Gurevich, Ido Levi, Yehonatan Marziano, Michael Kalinin, Natalya Bilenko, Daniel LandauABSTRACT
Aims
To investigate the association between serum ALP levels and the development of AKI in paediatric patients with sepsis.
Methods
Retrospective screening of a computerized database of 4 Israeli regional hospitals for children (0–18 years) hospitalized between 1.01.2000–1.06.2024 with ICD‐9 sepsis‐related diagnoses (study group) and age‐ and sex‐matched non‐septic febrile patients (controls). Serum ALP levels were sex‐ and age‐adjusted and described as standard deviation scores (SDS).
Results
Of 809 952 screened hospitalizations, 701 records comprised the study group. Their median (IQR) age was 17 (10–38) months, 53% were males. Nadir ALP‐SDS was lower in the sepsis group compared to controls (−1.65 ± 1.11 vs. −0.97 ± 1.36, p < 0.001) and further lower in those with AKI, which occurred in 23% of the sepsis cohort (−1.95 ± 1.16 vs. −1.56 ± 1.09, p < 0.001). Hospital stay was longer in the AKI compared to non‐AKI group [median (IQR): 7 (4, 12) vs. 4 (3, 5) days, p < 0.001]. Lower ALP‐SDS was independently associated with AKI [OR (95% CI): 0.7 (0.6–0.8), p < 0.001], after controlling for CRP and leucocyte count.
Conclusions
ALP was lower in sepsis patients compared to controls, and significantly lower in AKI vs. non‐AKI group, suggesting it as an additional marker of infection severity.