{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:31Z","timestamp":1784527411188,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Objective<\/jats:title>\n To develop and validate a nomogram for predicting the risk of severe acute kidney injury (AKI) in children with sepsis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 987 children with sepsis admitted to the pediatric intensive care unit (PICU) of Hunan Children's Hospital between July 2018 and January 2021 were enrolled. Patients were stratified into a severe AKI group (\n n<\/jats:italic>\n \u2009=\u2009228) and a no clinically significant AKI group (\n n<\/jats:italic>\n \u2009=\u2009759) according to the severity of AKI during hospitalization. Based on independent risk factors identified by multivariate logistic regression, a predictive nomogram was constructed. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Severe AKI occurred in 228 patients (23.1%). The mortality rate in the severe AKI group was 2.57-fold higher than that in the no clinically significant AKI group (31.1% vs. 12.5%,\n P<\/jats:italic>\n \u2009&lt;\u20090.05). Independent predictors of severe AKI included elevated phosphate (P\n 5+<\/jats:sup>\n ; per 1 mmol\/L increase:\n OR<\/jats:italic>\n \u2009=\u20092.789,\n 95% CI<\/jats:italic>\n \u2009=\u20091.693\u20134.592,\n P<\/jats:italic>\n \u2009&lt;\u20090.001), decreased albumin (ALB; per 1\u2005g\/L increase:\n OR<\/jats:italic>\n \u2009=\u20090.930,\n 95% CI<\/jats:italic>\n \u2009=\u20090.879\u20130.984,\n P<\/jats:italic>\n \u2009=\u20090.012), elevated uric acid (UA; per 1\u2005\u03bcmol\/L increase:\n OR<\/jats:italic>\n \u2009=\u20091.004,\n 95% CI<\/jats:italic>\n \u2009=\u20091.003\u20131.005,\n P<\/jats:italic>\n \u2009&lt;\u20090.001), and reduced antithrombin III (AT3; per 1% increase:\n OR<\/jats:italic>\n \u2009=\u20090.990,\n 95% CI<\/jats:italic>\n \u2009=\u20090.980\u20130.999,\n P<\/jats:italic>\n \u2009=\u20090.048). The logistic regression model showed moderate discrimination with an area under the ROC curve (AUC) of 0.782 (\n 95% CI<\/jats:italic>\n \u2009=\u20090.744\u20130.819). The corresponding nomogram achieved an AUC of 0.761 (\n 95% CI<\/jats:italic>\n \u2009=\u20090.724\u20130.797). At their optimal cutoff values, the model and nomogram yielded sensitivities of 60.10% and 62.70%, specificities of 85.40% and 80.80%, and Youden indices of 0.455 and 0.435, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Severe AKI is strongly associated with increased mortality in pediatric sepsis. The nomogram incorporating P\n 5+<\/jats:sup>\n , ALB, UA, and AT3 shows moderate discrimination, acceptable calibration, and potential clinical utility for predicting severe AKI in children with sepsis.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1822958","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:33:59Z","timestamp":1784525639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors and a nomogram for predicting severe acute kidney injury in pediatric sepsis: a retrospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yiru","family":"Xiang","sequence":"first","affiliation":[{"name":"The School of Pediatrics, Hengyang Medical School, University of South China (Hunan Children's Hospital)","place":["Hengyang, 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Medical School, University of South China (Hunan Children's Hospital)","place":["Hengyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xun","family":"Li","sequence":"additional","affiliation":[{"name":"The School of Pediatrics, Hengyang Medical School, University of South China (Hunan Children's Hospital)","place":["Hengyang, China"]},{"name":"Pediatrics Research Institute of Hunan Province, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital)","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Qiu","sequence":"additional","affiliation":[{"name":"Pediatrics Research Institute of Hunan Province, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital)","place":["Changsha, 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