The risk factors for secondary liver injury in children with sepsis and the predictive value of serum S100A9,TRAF6,and PRDX1

Yang Fengxia; Liao Kaili; Wu Sifei; Fang Chunxiao

doi:10.3969/j.issn.1671-6450.2025.11.014

Abstract：Objective To explore the risk factors for secondary liver injury in children with sepsis and the predictive value of serum S100 calcium-binding protein A9(S100A9),tumor necrosis factor receptor-associated factor 6(TRAF6),and peroxiredoxin-1(PRDX1).Methods Eighty-three children with sepsis secondary to liver injury admitted to the Department of Infectious Diseases of the Affiliated Women's and Children's Medical Center of Guangzhou Medical University from Janu-ary 2022 to January 2025 were selected as the liver injury group,and 126 children without secondary liver injury were selected as the non-liver injury group.The liver injury group was further classified into 34 cases of severe,27 cases of moderate,and 22 cases of mild according to the degree of liver injury.Serum levels of S100A9,TRAF6,and PRDX1 were detected using the ELISA method.Multifactorial logistic regression analysis was used to identify risk factors affecting secondary liver injury.Rel-ative risk analysis was performed to assess the impact of different serum levels of S100A9,TRAF6,and PRDX1 on secondary liver injury.The predictive value of serum S100A9,TRAF6,and PRDX1 for secondary liver injury was evaluated using ROC curve analysis.Results The liver injury group had higher APACHE Ⅱ scores,SOFA scores,AST,ALT,S100A9,TRAF6,and PRDX1 levels than the non-liver injury group(t=5.300,2.401,15.638,17.510,8.160,8.716,7.770,P＜0.001).Serum levels of S100A9,TRAF6,and PRDX1 in children with different degrees of liver injury increased with the severity of injury(F=11.973,14.261,14.659,P＜0.001).Higher APACHE Ⅱ scores and elevated levels of AST,ALT,S100A9,TRAF6,and PRDX1 were identified as risk factors for secondary liver injury in children with sepsis[OR(95％CI)=1.672(1.141-2.450),2.683(1.436-5.014),2.945(1.495-5.802),3.065(1.709-5.497),3.271(1.799-5.947),2.986(1.573-5.668)].The AUCs of serum S100A9,TRAF6,PRDX1,and the combination of the three for predicting secondary liver injury in children with sepsis were 0.844,0.818,0.833,and 0.936,respectively.The combination of the three markers was superior to the AUCs predicted by each of serum S100A9,TRAF6,and PRDX1 individually(Z=3.336,3.679,3.213,P=0.001,＜0.001,0.001).Conclusion Higher APACHE Ⅱ scores and elevated levels of AST,ALT,S100A9,TRAF6,and PRDX1 are risk factors for secondary liver injury in children with sepsis.The combined detection of serum S100A9,TRAF6,and PRDX1 has a high predictive value for sec-ondary liver injury in children with sepsis.