Natalja L Stanski1, Erin K Stenson2, Natalie Z Cvijanovich3, Scott L Weiss4, Julie C Fitzgerald4, Michael T Bigham5, Parag N Jain6, Adam Schwarz7, Riad Lutfi8, Jeffrey Nowak9, Geoffrey L Allen10, Neal J Thomas11, Jocelyn R Grunwell12, Torrey Baines13, Michael Quasney14, Bereketeab Haileselassie15, Hector R Wong1,16. 1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 2. Children's Hospital Colorado, Aurora, Colorado. 3. University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California. 4. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Akron Children's Hospital, Akron, Ohio. 6. Texas Children's Hospital and Baylor College of Medicine, Houston, Texas. 7. Children's Hospital of Orange County, Orange, California. 8. Riley Hospital for Children, Indianapolis, Indiana. 9. Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota. 10. Children's Mercy Hospital, Kansas City, Missouri. 11. Penn State Hershey Children's Hospital, Hershey, Pennsylvania. 12. Children's Healthcare of Atlanta at Eggleston, Atlanta, Georgia. 13. University of Florida Health, Gainesville, Florida. 14. C.S. Mott Children's Hospital at the University of Michigan, Ann Arbor, Michigan. 15. Lucile Packard Children's Hospital Stanford, Palo Alto, California; and. 16. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Abstract
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 (D3 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 D3 SA-AKI. The proportion of patients developing severe D3 SA-AKI increased directly with increasing PERSEVERE-II risk category, and increasing PERSEVERE-II mortality probability was independently associated with increased odds of severe D3 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 D3 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 D3 SA-AKI and identify patients with early AKI who are likely to recover.
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 (D3 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 D3 SA-AKI. The proportion of patients developing severe D3 SA-AKI increased directly with increasing PERSEVERE-II risk category, and increasing PERSEVERE-II mortality probability was independently associated with increased odds of severe D3 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 D3 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 D3 SA-AKI and identify patients with early AKI who are likely to recover.
Authors: Hector R Wong; Thomas P Shanley; Bhuvaneswari Sakthivel; Natalie Cvijanovich; Richard Lin; Geoffrey L Allen; Neal J Thomas; Allan Doctor; Meena Kalyanaraman; Nancy M Tofil; Scott Penfil; Marie Monaco; Mary Ann Tagavilla; Kelli Odoms; Katherine Dunsmore; Michael Barnes; Bruce J Aronow Journal: Physiol Genomics Date: 2007-03-20 Impact factor: 3.107
Authors: R Scott Watson; Joseph A Carcillo; Walter T Linde-Zwirble; Gilles Clermont; Jeffrey Lidicker; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2002-11-14 Impact factor: 21.405
Authors: Eric A J Hoste; Sean M Bagshaw; Rinaldo Bellomo; Cynthia M Cely; Roos Colman; Dinna N Cruz; Kyriakos Edipidis; Lui G Forni; Charles D Gomersall; Deepak Govil; Patrick M Honoré; Olivier Joannes-Boyau; Michael Joannidis; Anna-Maija Korhonen; Athina Lavrentieva; Ravindra L Mehta; Paul Palevsky; Eric Roessler; Claudio Ronco; Shigehiko Uchino; Jorge A Vazquez; Erick Vidal Andrade; Steve Webb; John A Kellum Journal: Intensive Care Med Date: 2015-07-11 Impact factor: 17.440
Authors: Rafael S A Lima; Cristina N Marques; Geraldo B Silva Júnior; Aline S Barbosa; Eveline S Barbosa; Rosa M S Mota; Sônia M H A Araújo; Oswaldo A Gutiérrez-Adrianzén; Alexandre B Libório; Elizabeth F Daher Journal: Int Urol Nephrol Date: 2008-03-27 Impact factor: 2.370
Authors: Melanie Meersch; Christoph Schmidt; Andreas Hoffmeier; Hugo Van Aken; Carola Wempe; Joachim Gerss; Alexander Zarbock Journal: Intensive Care Med Date: 2017-01-21 Impact factor: 17.440
Authors: Erin K Stenson; Zhiying You; Ron Reeder; Jesse Norris; Halden F Scott; Bradley P Dixon; Joshua M Thurman; Ashley Frazer-Abel; Peter Mourani; Jessica Kendrick Journal: Kidney360 Date: 2021-10-07
Authors: Mihir R Atreya; Natalie Z Cvijanovich; Julie C Fitzgerald; Scott L Weiss; Michael T Bigham; Parag N Jain; Adam J Schwarz; Riad Lutfi; Jeffrey Nowak; Geoffrey L Allen; Neal J Thomas; Jocelyn R Grunwell; Torrey Baines; Michael Quasney; Bereketeab Haileselassie; Christopher J Lindsell; Matthew N Alder; Hector R Wong Journal: Crit Care Date: 2022-07-11 Impact factor: 19.334
Authors: James D Odum; Steve Standage; Matthew Alder; Basilia Zingarelli; Prasad Devarajan; Hector R Wong Journal: Shock Date: 2022-02-28 Impact factor: 3.533
Authors: Kathleen D Liu; Stuart L Goldstein; Anitha Vijayan; Chirag R Parikh; Kianoush Kashani; Mark D Okusa; Anupam Agarwal; Jorge Cerdá Journal: Clin J Am Soc Nephrol Date: 2020-04-21 Impact factor: 8.237
Authors: Robinder G Khemani; Jessica T Lee; David Wu; Edward J Schenck; Margaret M Hayes; Patricia A Kritek; Gökhan M Mutlu; Hayley B Gershengorn; Rémi Coudroy Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Natalja L Stanski; Hector R Wong; Rajit K Basu; Natalie Z Cvijanovich; Julie C Fitzgerald; Scott L Weiss; Michael T Bigham; Parag N Jain; Adam Schwarz; Riad Lutfi; Jeffrey Nowak; Geoffrey L Allen; Neal J Thomas; Jocelyn R Grunwell; Michael Quasney; Bereketeab Haileselassie; Lakhmir S Chawla; Stuart L Goldstein Journal: Kidney Int Rep Date: 2021-05-01