To develop and validate a nomogram for predicting the risk of severe acute kidney injury (AKI) in children with sepsis.
Approach:
Study Design: Retrospective analysis of 987 children with sepsis admitted to the pediatric intensive care unit (PICU) from July 2018 to January 2021.
Patient Stratification: Patients were divided into a severe AKI group (n = 228) and a no clinically significant AKI group (n = 759).
Risk Factor Identification: Independent risk factors were identified using multivariate logistic regression.
Nomogram Development: A predictive nomogram was constructed based on identified risk factors.
Model Evaluation: Model performance was assessed using ROC curves, calibration curves, and decision curve analysis (DCA).
Key Findings:
Severe AKI occurred in 23.1% of patients.
The mortality rate in the severe AKI group was 31.1%, compared to 12.5% in the no clinically significant AKI group (P < 0.05).
Independent predictors of severe AKI included elevated phosphate, decreased albumin, elevated uric acid, and reduced antithrombin III.
The logistic regression model showed moderate discrimination with an AUC of 0.782.
The nomogram achieved an AUC of 0.761.
Interpretation:
Severe AKI is associated with increased mortality in pediatric sepsis, and the developed nomogram shows moderate discrimination.
Limitations:
The study is retrospective and conducted in a single center.
The generalizability of the findings may be limited.
Conclusion:
The nomogram incorporating P5+, ALB, UA, and AT3 demonstrates moderate discrimination and calibration for predicting severe AKI in children with sepsis.
