Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Pediatr Crit Care Med. 2024 Nov 1;25(11):1005-1016. doi: 10.1097/PCC.0000000000003589. Epub 2024 Aug 6.
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.
A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.
Ten PICUs in the United States.
Children with septic shock 1 week to 18 years old admitted to the PICU.
None.
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).
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.
我们之前推导出了更新的儿科脓毒症生物标志物急性肾损伤风险（PERSEVERE-II AKI）预测模型，该模型对脓毒性休克第 3 天（D3 严重 AKI）的严重 AKI 具有良好的诊断测试特征。现在，我们希望在与模型开发时不同的独立队列中验证该模型。
这是一项多中心、前瞻性、观察性研究的二次分析，于 2019 年 1 月至 2022 年 12 月进行。
美国的 10 个 PICUs。
年龄在 1 周至 18 岁之间，因脓毒性休克被收入 PICU 的儿童。
无。
363 名患者中有 79 名（22%）出现 D3 严重 AKI，定义为肾脏病改善全球结局（KDIGO）第 2 期或更高期的 AKI。使用 PERSEVERE-II AKI 模型为患者分配 D3 严重 AKI 的可能性。该模型对 D3 严重 AKI 的预测的受试者工作特征曲线下面积为 0.89（95%置信区间，0.85-0.93），敏感性为 77%（95%置信区间，66-86%），特异性为 88%（95%置信区间，84-92%），阳性预测值为 65%（95%置信区间，54-74%），阴性预测值为 93%（95%置信区间，89-96%）。这些数据代表 D3 严重 AKI 的阳性检测后，D3 严重 AKI 的患病概率从 22%增加到 65%，患病率阈值为 28%。在多变量回归中，PERSEVERE-II AKI 预测模型显示 D3 严重 AKI 的调整后比值比（aOR）更高（aOR，11.2；95%置信区间，4.9-25.3），而 D3 肾功能从早期 AKI 恢复失败的 aOR 更低（aOR，0.31；95%置信区间，0.13-0.69）。
PERSEVERE-II AKI 模型在预测脓毒性休克儿童新发生或持续的 D3 严重 AKI 方面表现出一致的稳健性能。主要限制是实际的 D3 严重 AKI 患病率低于检测的患病率阈值，因此未来的工作应集中在评估在富集人群中的应用。
