Natalja L Stanski, Bin Zhang, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Geoffrey L Allen, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Stuart L Goldstein
{"title":"小儿脓毒症生物标志物风险 II 用于小儿脓毒性休克急性肾损伤预测模型的最新诊断验证。","authors":"Natalja L Stanski, Bin Zhang, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Geoffrey L Allen, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Stuart L Goldstein","doi":"10.1097/PCC.0000000000003589","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.</p><p><strong>Setting: </strong>Ten PICUs in the United States.</p><p><strong>Patients: </strong>Children with septic shock 1 week to 18 years old admitted to the PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock.\",\"authors\":\"Natalja L Stanski, Bin Zhang, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Geoffrey L Allen, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Stuart L Goldstein\",\"doi\":\"10.1097/PCC.0000000000003589\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.</p><p><strong>Setting: </strong>Ten PICUs in the United States.</p><p><strong>Patients: </strong>Children with septic shock 1 week to 18 years old admitted to the PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003589\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003589","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目标：我们之前建立了最新的儿科脓毒症急性肾损伤生物标志物风险（PERSEVERE-II AKI）预测模型，该模型对脓毒性休克第3天的重度AKI（D3重度AKI）具有可靠的诊断测试特征。现在，我们试图在一个独立的儿童队列中验证这一模型：对 2019 年 1 月至 2022 年 12 月期间开展的一项多中心、前瞻性观察研究进行二次分析：美国十所儿童重症监护病房：干预措施：无：无干预措施：363名患者中有79名（22%）患有D3重度AKI，定义为肾病改善全球结果2期或更高。采用 PERSEVERE-II AKI 模型对患者的 D3 重度 AKI 概率进行了分配。该模型预测 D3 重度 AKI 的接收者操作特征曲线下面积为 0.89（95% CI，0.85-0.93），灵敏度为 77%（95% CI，66-86%），特异性为 88%（95% CI，84-92%），阳性预测值为 65%（95% CI，54-74%），阴性预测值为 93%（95% CI，89-96%）。这些数据表明，检测结果呈阳性时，D3 重度 AKI 的检测后概率从 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 重度 AKI 的调整赔率 (aOR) 较大（aOR，11.2；95% CI，4.9-25.3），而 D3 早期 AKI 肾功能恢复失败的 aOR 较小（aOR，0.31；95% CI，0.13-0.69）：结论：PERSEVERE-II AKI模型在预测脓毒性休克患儿新发或持续性D3重度AKI方面一直表现稳健。一个主要的局限性是，D3重度AKI的实际发病率低于该测试的发病率阈值，因此未来的工作应侧重于评估在丰富人群中的使用情况。
Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock.
Objectives: 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.
Design: A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.
Setting: Ten PICUs in the United States.
Patients: Children with septic shock 1 week to 18 years old admitted to the PICU.
Interventions: None.
Measurements and main results: 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).
Conclusions: 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.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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