Pediatric anesthesia & critical care
External Validation, Molecular Signatures, and Therapeutic Relevance of Pediatric Sepsis-Associated Acute Kidney Injury Subphenotypes
Authors' conclusion
We externally validated the prognostic relevance of two pSAKI subphenotypes derived from readily available data. These subphenotypes have unique biomarker signatures and differential responses to treatment
Study context
- Population
- Children 1 week to 18 years with early (day 1–2) sepsis-associated AKI, 10 US PICUs, 2002–2025
- Participants
- 871 children
- Comparison
- pSAKI-2 vs pSAKI-1 subphenotype
- pSAKI-2n = 206
- pSAKI-1n = 665reference
Methodological detailspropensity-score matched, inverse probability treatment weighting
- Propensity-score matched
- Inverse probability treatment weighting
Primary result
As reported in the abstract
Day 7 severe AKI and death (pSAKI-2 vs pSAKI-1)
pSAKI-2 vs pSAKI-1Adjusted odds ratio (95% CI)P value
Day 7 severe AKI
3.2(2.1–4.7)
P < 0.001Death
2.7(1.6–4.4)
P < 0.001- Fewer PICU-free and vasoactive-free days in pSAKI-2
- P < 0.001
Further findings
Biomarker signature of pSAKI-2
- Greater inflammation, endothelial dysfunction and hyperreninemia
Corticosteroids vs none in pSAKI-1 (propensity score matched (PSM)): day 7 severe AKI, PICU-free days, mortality
- Day 7 severe AKI 28% vs 19%
- P = 0.023
- 2 fewer PICU-free days
- P = 0.04
- Mortality 10% vs 3.7%
- P = 0.008
- No differences in pSAKI-2
- Propensity score matched
Vasopressin heterogeneity of treatment effect (HTE) (vasoactive-free days)
- Significant subphenotype–vasopressin interaction on IPTW for vasoactive-free days
- P = 0.003
- No HTE on PSM analysis
Original publication
External Validation, Molecular Signatures, and Therapeutic Relevance of Pediatric Sepsis-Associated Acute Kidney Injury Subphenotypes. Crit Care Med. Published 30 March 2026. doi:10.
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