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Risk factors for predicting acute kidney injury in children with septic shock: a retrospective cohort study

Yu Fang1,2, Weihong Zheng1,2, Kepei Chen1,2

  • 1Department of Pediatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Pediatric Nephrology (Berlin, Germany)
|June 11, 2025
PubMed

Insights

This study identified key risk factors for acute kidney injury (AKI) in children with septic shock, developing a predictive nomogram for early risk assessment and intervention. The nomogram demonstrated high accuracy in predicting sepsis-associated AKI (SA-AKI).

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Clinical Epidemiology

Background:

  • Acute kidney injury (AKI) is a significant complication in pediatric septic shock.
  • Risk factors for AKI in this vulnerable population are not well-established.
  • Early identification and intervention are crucial for improving outcomes.

Purpose of the Study:

  • To identify independent risk factors for sepsis-associated AKI (SA-AKI) in children with septic shock.
  • To develop and validate a clinical predictive model (nomogram) for early SA-AKI risk assessment.
  • To enhance the management of pediatric patients experiencing septic shock.

Main Methods:

  • Retrospective analysis of clinical data from 180 pediatric patients with septic shock.
  • Multivariate analysis to determine significant predictors of AKI.
  • Development and validation of a clinical nomogram using R software and bootstrap resampling.

Main Results:

  • The incidence of AKI was 44.4%. Significant predictors included greater height, positive random proteinuria, elevated procalcitonin, base excess, increased blood urea nitrogen, and prolonged prothrombin time.
  • Early antibiotic use showed a protective effect.
  • The developed nomogram achieved an AUC of 0.895, demonstrating high predictive accuracy, sensitivity (77.1%), and specificity (88.9%).

Conclusions:

  • Identified risk factors enable timely interventions for pediatric septic shock patients.
  • The validated nomogram is a valuable clinical tool for improving SA-AKI management.
  • Early risk assessment and intervention can potentially enhance patient outcomes.
Abstract

Keywords:
Acute kidney injuryClinical prediction modelNomogramRisk factorsSepsisSeptic shock

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