Murat MURATOGLU, Busra BULUT, Ali Reza MANEVI, Hazal Selvi YILDIRIM, Seda KILICOGLU TANIR, Mohammad Sajad CHERAQI, Adem SAFAK, Sedat YILDIRIM, Mehmet HABERAL
Experimental and Clinical Transplantation - 2026;24(6):450-459
Objectives: In renal transplant recipients, infections can have atypical outcomes due to immunosuppression therapy, and delayed diagnosis causes high mortality. We developed an infection risk score in renal transplant recipients to rapidly predict infection risk in emergency departments. Materials and Methods: Of 870 renal transplant recipients admitted to the emergency department, we included 608 patients and 262 control cases. Hospital record system data for renal transplant recipients were retrospectively investigated for the period January 2021 through December 2025. Laboratory and vital signs of patients suspected of infection were compared versus asymptomatic control cases admitted for routine check-ups. All of our patients met ethical standards and were selected as related donors and recipients. Results: Demographic characteristics and findings of 608 patients and 262 control cases were compared, and no significant difference was found between the 2 groups in terms of comorbidities ( P > .05). The most frequent presenting symptom was diarrhea (20.1%); the least frequent symptom was sore throat (6.6%). Leukocytes, neutrophils, neutrophil-lymphocyte ratio, plasma-lymphocyte ratio, C-reactive protein, and sodium and potassium levels, as well as vital signs including fever, pulse, blood pressure, and peripheral oxygen saturation, were associated with infection. This novel infection risk score comprised 6 parameters, including C-reactive protein, neutrophil-lymphocyte ratio, sodium, fever, pulse, and systolic blood pressure, predicted infections with 89.1% (area under the curve) accuracy. Sensitivity, specificity, positive predictive value, and negative predictive value of the score were 0.734, 0.905, 0.947, and 0.594, respectively. Conclusions: The novel infection risk score developed in our study predicts infections in renal transplant recipients with high accuracy using only routine biochemical and vital parameters. This practical, rapid, and reliable system can contribute to early diagnosis processes in emergency departments. Future external validation through multicenter studies is needed to support its integration into clinical guidelines.
