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Full text release has been delayed at the author's request until April 25, 2025

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External Validation of the PERSEVERE-II AKI Prediction Model in Pediatric Septic Shock

Stanski, Natalja
http://orcid.org/0000-0003-4473-8376
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1712916436915202

Abstract Details

2024, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Purpose: Acute kidney injury (AKI) is common in pediatric septic shock and confers increased risk for poor outcomes. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously derived the PERSEVERE-II AKI Model, which had excellent predictive performance for severe AKI at Day 3 of pediatric septic shock (D3 severe AKI). We sought to externally validate the PERSEVERE-II AKI Model for prediction of D3 severe AKI in a separate cohort of children. Methods: We performed a secondary analysis of a multicenter, prospective, observational study of children with septic shock aged 1 week to 18 years admitted to the pediatric intensive care unit from 1/2019-12/2022. The primary outcome was D3 severe AKI (=KDIGO Stage 2). Patients were assigned a probability of D3 severe AKI based on our previously derived model using the PERSEVERE biomarkers, PERSEVERE-II mortality probability, and Day 1 (D1) KDIGO AKI stage. Model performance was assessed and compared to D1 context-free serum creatinine (SCr) elevation. Results: Seventy-nine of 363 patients (22%) had D3 severe AKI. The PERSEVERE-II AKI Model predicted D3 severe AKI with AUC 0.89 (95%CI 0.85-0.93), sensitivity 77% (95%CI 66-86), specificity 88% (95%CI 84-92), PPV 65% (95%CI 54-74), and NPV 93% (89-96); model performance was superior to D1 SCr elevation above baseline (AUC 0.82, 95%CI 076-0.88, p=0.004). On multivariable regression, PERSEVERE-II model prediction was the strongest independent predictor of D3 severe AKI (aOR 11.2, 95%CI 4.9-25.3, p<0.001). Conclusion: The PERSEVERE-II AKI Model demonstrates excellent performance for prediction of D3 severe AKI in children with septic shock, outperforming D1 context-free SCr elevation alone. Timely biomarker availability is necessary to translate this tool to the bedside.
Patrick Ryan, Ph.D. (Committee Chair)
Bin Zhang, Ph.D. (Committee Member)
Stuart Goldstein, M.D. (Committee Member)
17 p.
Surgery
acute kidney injury; sepsis; pediatrics; enrichment; prediction; precision medicine

Recommended Citations

Citations

  • Stanski, N. (2024). External Validation of the PERSEVERE-II AKI Prediction Model in Pediatric Septic Shock [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1712916436915202

    APA Style (7th edition)

  • Stanski, Natalja. External Validation of the PERSEVERE-II AKI Prediction Model in Pediatric Septic Shock. 2024. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1712916436915202.

    MLA Style (8th edition)

  • Stanski, Natalja. "External Validation of the PERSEVERE-II AKI Prediction Model in Pediatric Septic Shock." Master's thesis, University of Cincinnati, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1712916436915202

    Chicago Manual of Style (17th edition)

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This open access ETD is published by University of Cincinnati and OhioLINK.