Prognostic and predictive value of endothelial dysfunction biomarkers in sepsis-associated acute kidney injury: risk-stratified analysis from a prospective observational cohort of pediatric septic shock
Authors' conclusion
Endothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI.
Study context
- Population
- Children with septic shockderivation cohort
- Participants
- 414 children
- Comparison
- Children with vs without D3 sepsis-associated acute kidney injury (SA-AKI) SCr; risk strata by PERSEVERE-II
- Primary endpoint
- ≥ Stage II KDIGO SA-AKI based on serum creatinine (D3 SA-AKI SCr)
- Follow-up
- Day 3
Methodological detailsprespecified subgroups, Classification and Regression Tree (CART) prediction model, tenfold cross-validation
- Prespecified subgroups
- CART prediction model
- Tenfold cross-validation
Primary result
As reported in the abstract
Association of D1 endothelial markers with D3 SA-AKI SCr
- Soluble thrombomodulin (sTM), Angpt-2 and Tie-2 independently associated with D3 SA-AKI SCr
- Tie-2 and Angpt-2/Tie-2 ratios influenced by interaction between D3 SA-AKI SCr and risk strata
- Multivariable regression
Further findings
CART model (6 terminal nodes) in high- or intermediate-PERSEVERE-II risk strata
- AUROC in derivation cohort
- 0.90
- AUROC upon tenfold cross-validation
- 0.77
- High specificity
Model performance in unique set of patients
- Patients in test set
- 224
- High- or intermediate-PERSEVERE-II risk
- 84
- Performed modestly to distinguish high vs low risk of D3 SA-AKI SCr
Clinical outcomes in D3 SA-AKI SCr
- Worse outcomes incl. 28-day mortality and need for continuous renal replacement therapy (CRRT)
Original publication
Prognostic and predictive value of endothelial dysfunction biomarkers in sepsis-associated acute kidney injury: risk-stratified analysis from a prospective observational cohort of pediatric septic shock. Crit Care. Published 3 July 2023. doi:10.
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