Diagnostic Value of MicroRNAs as Biomarkers for Sepsis-associated Acute Kidney Injury: A Systematic Review and Meta-Analysis

Abstract

Introduction. Sepsis-associated acute kidney injury (SA-AKI) 
is a common and serious complication in critically ill patients, 
associated with high morbidity and mortality. Early diagnosis 
remains challenging due to the limitations of traditional biomarkers 
such as serum creatinine and urine output. MicroRNAs (miRNAs) 
and circular RNAs (circRNAs) have emerged as promising non
invasive biomarkers for early SA-AKI detection. To systematically 
evaluate the diagnostic accuracy of individual non-coding RNA 
biomarkers for predicting SA-AKI in sepsis patients.
Methods. We systematically searched PubMed from inception to 
August 2026 and manually screened reference lists of relevant 
systematic reviews. Studies were included if they evaluated non
coding RNAs for SA-AKI diagnosis in sepsis patients, compared 
sepsis patients with AKI to sepsis patients without AKI. 
Results. Fourteen studies comprising 1,840 patients (908 with 
SA-AKI and 932 controls) were included. The pooled sensitivity 
was 83.5% and pooled specificity was 81.5%. The pooled DOR 
was 22.29, and the area under the HSROC curve was 0.885, 
indicating excellent diagnostic accuracy. The most promising 
individual biomarkers identified were miR-210 (AUC = 0.913), 
miR-155 (AUC = 0.910), miR-132-3p (AUC = 0.910), and miR-769
5p (AUC = 0.928). Heterogeneity was low to moderate (I²: 30.4 
to 35.9% for sensitivity, 0.8 to 0.9% for specificity).
Conclusions. Individual non-coding RNA biomarkers demonstrate 
good to excellent diagnostic accuracy for SA-AKI, with performance 
comparable to or exceeding that of established protein biomarkers. 
Their biological plausibility, stability in body fluids, and potential 
for early detection make them attractive candidates for clinical 
translation.