Open AccessPERSEVERE Biomarkers Predict Severe Acute Kidney Injury and Renal Recovery in Pediatric Septic Shock
Author(s) -
Natalja L. Stanski,
Erin K. Stenson,
Natalie Z. Cvijanovich,
Scott L. Weiss,
Julie C. Fitzgerald,
Michael T. Bigham,
Parag Jain,
Adam Schwarz,
Riad Lutfi,
Jeffrey Nowak,
Geoffrey L. Allen,
Neal J. Thomas,
Jocelyn R. Grunwell,
Torrey Baines,
Michael W. Quasney,
Bereketeab Haileselassie,
Hector R. Wong
Publication year - 2020
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.201911-2187oc
Subject(s) - medicine , acute kidney injury , septic shock , odds ratio , sepsis , renal replacement therapy , intensive care medicine , kidney disease , confidence interval , severity of illness , prospective cohort study
Rationale: Acute kidney injury (AKI), a common complication of sepsis, is associated with substantial morbidity and mortality and lacks definitive disease-modifying therapy. Early, reliable identification of at-risk patients is important for targeted implementation of renal protective measures. The updated Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) is a validated, multibiomarker prognostic enrichment strategy to estimate baseline mortality risk in pediatric septic shock. Objectives: To assess the association between PERSEVERE-II mortality probability and the development of severe, sepsis-associated AKI on Day 3 (D 3 SA-AKI) in pediatric septic shock. Methods: We performed secondary analysis of a prospective observational study of children with septic shock in whom the PERSEVERE biomarkers were measured to assign a PERSEVERE-II baseline mortality risk. Measurements and Main Results: Among 379 patients, 65 (17%) developed severe D 3 SA-AKI. The proportion of patients developing severe D 3 SA-AKI increased directly with increasing PERSEVERE-II risk category, and increasing PERSEVERE-II mortality probability was independently associated with increased odds of severe D 3 SA-AKI after adjustment for age and illness severity (odds ratio, 1.4; 95% confidence interval, 1.2-1.7; P < 0.001). Similar associations were found between increasing PERSEVERE-II mortality probability and the need for renal replacement therapy. Lower PERSEVERE-II mortality probability was independently associated with increased odds of renal recovery among patients with early AKI. A newly derived model incorporating the PERSEVERE biomarkers and Day 1 AKI status predicted severe D 3 SA-AKI with an area under the received operating characteristic curve of 0.95 (95% confidence interval, 0.92-0.98). Conclusions: Among children with septic shock, the PERSEVERE biomarkers predict severe D 3 SA-AKI and identify patients with early AKI who are likely to recover.