Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock-Reference-Cited by-同舟云学术

Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock

Published:2024-08-06 Issue: Volume: Page:
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Stanski Natalja L.¹²^ORCID,Zhang Bin³,Cvijanovich Natalie Z.⁴,Fitzgerald Julie C.⁵⁶,Bigham Michael T.⁷,Jain Parag N.⁸,Schwarz Adam J.⁹,Lutfi Riad¹⁰,Allen Geoffrey L.¹¹,Thomas Neal J.¹²,Baines Torrey¹³,Haileselassie Bereketeab¹⁴,Weiss Scott L.¹⁵,Atreya Mihir R.¹²,Lautz Andrew J.¹²,Zingarelli Basilia¹²,Standage Stephen W.¹²,Kaplan Jennifer¹²,Goldstein Stuart L.²¹⁶

Affiliation:

1. Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

4. Division of Critical Care Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA.

5. Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

6. Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

7. Division of Critical Care Medicine, Akron Children’s Hospital, Akron, OH.

8. Division of Critical Care Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX.

9. Division of Critical Care Medicine, Children’s Hospital of Orange County, Orange, CA.

10. Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, IN.

11. Division of Critical Care Medicine, Children’s Mercy Hospital, Kansas City, MO.

12. Division of Critical Care Medicine, Penn State Hershey Children’s Hospital, Hershey, PA.

13. Division of Critical Care Medicine, University of Florida Health Shands Children’s Hospital, Gainesville, FL.

14. Division of Critical Care Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA.

15. Division of Critical Care Medicine, Nemours Children’s Health, Wilmington, DE.

16. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

Abstract

OBJECTIVES: We previously derived the updated Pediatric Sepsis Biomarker Risk for Acute Kidney Injury (PERSEVERE-II AKI) prediction model, which had robust diagnostic test characteristics for severe AKI on day 3 (D3 severe AKI) of septic shock. We now sought to validate this model in an independent cohort of children to the one in which the model was developed. DESIGN: A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022. SETTING: Ten PICUs in the United States. PATIENTS: Children with septic shock 1 week to 18 years old admitted to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Seventy-nine of 363 patients (22%) had D3 severe AKI, defined as Kidney Disease Improving Global Outcomes stage 2 or higher. Patients were assigned a probability of D3 severe AKI using the PERSEVERE-II AKI model. The model predicted D3 severe AKI with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.85–0.93), sensitivity of 77% (95% CI, 66–86%), specificity of 88% (95% CI, 84–92%), positive predictive value of 65% (95% CI, 54–74%), and negative predictive value of 93% (95% CI, 89–96%). These data represent an increase in post-test probability of D3 severe AKI with a positive test from 22% to 65%, and a prevalence threshold of 28%. On multivariable regression, the PERSEVERE-II AKI prediction model demonstrated greater adjusted odds ratio (aOR) for D3 severe AKI (aOR, 11.2; 95% CI, 4.9–25.3) and lesser aOR for failure of D3 renal recovery from early AKI (aOR, 0.31; 95% CI, 0.13–0.69). CONCLUSIONS: The PERSEVERE-II AKI model demonstrates consistently robust performance for prediction of new or persistent D3 severe AKI in children with septic shock. A major limitation is that actual D3 severe AKI prevalence is below the prevalence threshold for the test, and thus future work should focus on evaluating use in enriched populations.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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