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Abstract: SA-OR87

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

Session Information

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Stanski, Natalja L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Treatment of sepsis-associated AKI (SA-AKI) is supportive, without effective therapies. Identification of patients at risk for severe SA-AKI could facilitate targeted kidney protection and enrich future trials. We derived the multi-biomarker PERSEVERE-II AKI Model that predicts Day (D) 3 severe SA-AKI with strong test characteristics (AUC 0.95, 95%CI 0.92-0.98, sensitivity 92%, specificity 89%). We aimed to prospectively validate this tool.

Methods

Secondary analysis of a prospective study of patients aged 0-25 admitted to 11 PICUs with septic shock from 3/19 to 12/22. D1 PERSEVERE biomarker values (C-C chemokine ligand 3, granzyme B [GZMB], heat shock protein 70 kD 1B [HSPA1B], IL-8 and MMP8) were combined with platelet count to assign a PERSEVERE-II mortality probability (PII MP). D1 KDIGO Stage, PII MP, GZMB, HSPA1B and IL-8 levels were used to assign a D3 severe AKI probability (Figure 1). Model performance was assessed and compared to D1 serum creatinine (SCr) elevation.

Results

Seventy-nine of 363 subjects (22%) had D3 severe AKI. The model predicted D3 severe AKI with an AUC 0.89 (95%CI 0.85-0.93), sensitivity 77% (95%CI 66-86) and specificity 88% (95%CI 84-92). Compared to subjects with D1 SCr-based AKI, those predicted to have severe AKI by the model (n=94) had more D3 severe SA-AKI (65% vs 45, p=0.003) and kidney replacement therapy use (40% vs 26%, p=0.021), and lower rates of renal recovery from early AKI (37% vs 53%, p=0.019) (Figure 2). Model performance was superior to D1 SCr elevation above baseline (p=0.004).

Conclusion

We have prospectively validated the PERSEVERE-II AKI Model for prediction of D3 severe AKI in pediatric septic shock. The next step to translating this tool to the bedside is timely biomarker availability.

Funding

  • Other NIH Support