Clinical characteristics and early identification of augmented renal clearance in PICU patients with severe sepsis associated with MRSA infection

Abstract

Objectives: To investigate the epidemiological characteristics of Augmented Renal Clearance (ARC) in severe sepsis children with MRSA infection and find risk factors to establish a model predicting ARC onset in PICU.

Design: Retrospective study, in which ARC was defined by estimated glomerular filtration rate (eGFR) measured by the modified Schwartz formula above 130 ml/min/1.73 m². Univariable and multivariable logistic regression analyses were performed to find the predictor for ARC. Multi-strategy modeling was used to form an early prediction model for ARC, which was evaluated by the area under the ROC curve (AUC), accuracy (ACC) and other indicators.

Setting: One China PICU.

Patients: Severe sepsis children with MRSA infection admitted to PICU from May 2017 to June 2022 at Children's Hospital of Nanjing Medical University.

Interventions: None.

Measurements and main results: 125 of 167 (74.9%) patients with severe sepsis with MRSA infection have occurred ARC during the hospitalization of PICU, of which 44% have an absolute decrease in vancomycin trough level (VTL), patients with ARC have a longer length of stay in both hospital and PICU, lower VTL and require longer anti-infective treatment. 20 different models were established for the early recognition of ARC. Among them, the best performer had an AUC of 0.746 and a high application prospect.

Conclusion: ARC is a phenomenon significantly underestimated in pediatric patients with severe sepsis associated with MRSA infection, which can affect 74.9% of these patients and affects the process of anti-infection treatment and clinical outcomes. To achieve early prediction only by specific risk factors is unreliable, a model based on Multivariate Logistic Regression in this study was chosen to be used clinically.

Keywords: MRSA; augmented renal clearance; prediction model; severe sepsis; vancomycin.