Heat shock protein 60 as a biomarker for acute kidney injury secondary to septic shock in pediatric patients, Egyptian multicenter experience

Acute kidney injury (AKI) is an independent predictor of morbidity and mortality for critically ill children at pediatric Intensive Care Units (PICU). It is proposed that heat shock protein 60 (HSP60) may be either a biomarker or a co-factor of survival in PICU. The aim of this work is to assess plasma levels of HSP60 in critically ill pediatric patients with AKI secondary to septic shock within the first 24 h of admission. This study was carried out on 120 pediatric patients admitted to PICUs of four university hospitals. They were divided into Group 1 included 60 patients meeting the criteria of AKI Network and septic shock, the second group included 60 critically ill patients without AKI or septic shock and the third group was 60 healthy children as controls. HSP60 levels were measured in the plasma using a commercially available ELISA and difference between groups were analyzed with a Kruskal-Wallis one-way ANOVA. P <0.05 was considered significant. There was highly significant increase in plasma levels of HSP60 in Group 1 (median 25.85 ng/mL) compared to both Group 2 (median 6.15 ng/mL) and healthy controls (median 4.35 ng/mL) (P <0.001). At a cut-off value ≥10 ng/mL, HSP60 sensitivity for prediction of cases with AKI secondary to septic shock was 96.67% with specificity 86.67%, positive predictive value 87.9%, negative predictive value 96.3%, AUC 0.993. HSP60 levels are significantly elevated in pediatric patients in Group 1 when compared to Groups 2 and 3. Hence, HSP60 may play a role in the pathogenesis of sepsis in pediatric patients.