Early prediction of acute kidney injury secondary to sepsis in the children with septic arthritis

Feng Yanhua; Ren Qiang; Li Jingyan

doi:10.3969/j.issn.1002-1949.2024.03.002

Abstract：Objective To explore the early predictive value of platelet to lymphocyte ratio(PLR)and high-density lipoprotein cholesterol(HDL-C)in secondary acute kidney injury(AKI)of the children with septic arthritis infection.Methods A total of 173 children with sepsis after septic arthritis infection admitted to the Orthopedic Department of the Children's Hospital of Hebei Province from June 2018 to October 2023 were chosen as the study subjects.According to whether secondary AKI occurred,they were divided into a non-AKI group(105 patients)and a AKI group(68 patients).The basic information of all pediatric patients at admission,laboratory indicators including blood routine,C-reactive protein(CRP),procalcitonin(PCT),serum creatinine(SCr),HDL-C,and pediatric sequential organ failure assessment(pSOFA)scores at admission were collected and analyzed statistically.The independent risk factors for secondary AKI were screened by Logistic regression analysis,and were used to construct a joint prediction model for evaluating the predictive value of meaningful indicators by receiver operating characteristic(ROC)curve analysis.Hosmer-Lemeshow goodness-of-fit test and Booststrap resampling method were used for internal validation of the accuracy of predictive models,the clinical decision curve analysis(DCA)was used to evaluate the clinical practicality of predictive models.Results ①There were statistically significant differences in PCT,PLR,HDL-C and pSOFA score between the AKI group and the non-AKI group(P<0.05).②Logistic regression analysis showed that PLR and HDL-C were independent risk factors for secondary AKI(P<0.05).③ROC curve analysis showed that the area under the curve(AUC)of PLR and HDL-C was 0.775 and 0.851,and 95%CI was 0.720-0.829 and 0.803-0.899.The AUC of the combined detection of two indicators was 0.912,and the 95%CI was 0.880-0.945.④The prediction results of the combined detection of two indicators after calibration were highly consistent with the clinical observations,and their predictive performance curve had good consistency with the curve observed in clinical practice.⑤Clinical DCA showed the threshold probability was 28%-80%,which can predict early secondary AKI in children with sepsis after septic arthritis infection.Conclusions PLR and HDL-C are independent risk factors for secondary AKI,and their combined detection has higher diagnostic value,which can be used to evaluate the risk of early secondary AKI in children with septic arthritis infection.