Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock.
Document Type
Article
Publication Date
11-1-2024
Identifier
DOI: 10.1097/PCC.0000000000003589
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.
Journal Title
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Volume
25
Issue
11
First Page
1005
Last Page
1016
MeSH Keywords
Humans; Acute Kidney Injury; Child, Preschool; Male; Infant; Child; Shock, Septic; Female; Prospective Studies; Biomarkers; Adolescent; Infant, Newborn; Risk Assessment; Intensive Care Units, Pediatric; ROC Curve; Risk Factors; Severity of Illness Index; Predictive Value of Tests
Keywords
Acute Kidney Injury; Septic Shock; Prospective Studies; Biomarkers; Risk Assessment; Pediatric Intensive Care Units; ROC Curve; Risk Factors; Severity of Illness Index; Predictive Value of Tests
Recommended Citation
Stanski NL, Zhang B, Cvijanovich NZ, et al. Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock. Pediatr Crit Care Med. 2024;25(11):1005-1016. doi:10.1097/PCC.0000000000003589
COinS
Comments
Grants and funding