Clinical characteristics and early identification of augmented renal clearance in PICU patients with severe sepsis associated with MRSA infection.

OBJECTIVES

To investigate the epidemiological characteristics of Augmented Renal Clearance (ARC) in severe sepsis children with MRSA infection and find risk factors to establish a model predicting ARC onset in PICU.

DESIGN

Retrospective study, in which ARC was defined by estimated glomerular filtration rate (eGFR) measured by the modified Schwartz formula above 130 ml/min/1.73 m. Univariable and multivariable logistic regression analyses were performed to find the predictor for ARC. Multi-strategy modeling was used to form an early prediction model for ARC, which was evaluated by the area under the ROC curve (AUC), accuracy (ACC) and other indicators.

SETTING

One China PICU.

PATIENTS

Severe sepsis children with MRSA infection admitted to PICU from May 2017 to June 2022 at Children's Hospital of Nanjing Medical University.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

125 of 167 (74.9%) patients with severe sepsis with MRSA infection have occurred ARC during the hospitalization of PICU, of which 44% have an absolute decrease in vancomycin trough level (VTL), patients with ARC have a longer length of stay in both hospital and PICU, lower VTL and require longer anti-infective treatment. 20 different models were established for the early recognition of ARC. Among them, the best performer had an AUC of 0.746 and a high application prospect.

CONCLUSION

ARC is a phenomenon significantly underestimated in pediatric patients with severe sepsis associated with MRSA infection, which can affect 74.9% of these patients and affects the process of anti-infection treatment and clinical outcomes. To achieve early prediction only by specific risk factors is unreliable, a model based on Multivariate Logistic Regression in this study was chosen to be used clinically.