Recalibration of the Renal Angina Index for Pediatric Septic Shock

• Type of Material: Article
• Authors: Natalja Stanski, Cincinnati Children's Hospital; Hector R Wong, Cincinnati Children's Hospital; Rajit Basu, Emory University; Natalie Z. Cvijanovich, University of California San Francisco; Julie C. Fitzgerald, Children's Hospital of Philadelphia; Scott L. Weiss, Children's Hospital of Philadelphia; Michael T. Bigham, Akron Children's Hospital; Parag N. Jain, Texas Children's Hospital; Adam Schwarz, Children's Hospital of Orange County; Riad Lutfi, Riley Hospital for Children; Jeffrey Nowak, Children’s Hospital and Clinics of Minnesota; Geoffrey Allen, Children's Mercy Hospital; Neal J. Thomas, Penn State Hershey Children's Hospital; Jocelyn Grunwell, Emory University; Michael Quasney, University of Michigan; Bereketeab Haileselassie, Lucile Packard Children's Hospital; Lakhmir S. Chawla, Veterans Affairs Medical Center San Diego; Stuart L. Goldstein, Cincinnati Children's Hospital
• Language: English
• Date: 2021-07-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2021 International Society of Nephrology. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2021.04.022
• Title of Journal or Parent Work: KIDNEY INTERNATIONAL REPORTS
• Volume: 6
• Issue: 7
• Start Page: 1858
• End Page: 1867
• Grant/Funding Information: Supported by the National Institute of General Medical Sciences, R35GM126943 (HRW), and the National Center for Advancing Translational Sciences of the National Institutes of Health, 2KL2TR001426-05A1 (NLS).
• Keywords: ACUTE KIDNEY INJURY; SEVERE SEPSIS; Science & Technology; acute kidney injury; precision medicine; FLUID OVERLOAD; Urology & Nephrology; septic shock; OUTCOMES; EPIDEMIOLOGY; PREDICTION; CRITICALLY-ILL CHILDREN; Life Sciences & Biomedicine; RISK; AKI; prediction; MULTICENTER
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Introduction: Sepsis-associated acute kidney injury (AKI) is a common diagnosis in children that is associated with poor outcomes. The lack of therapeutic options once present makes early identification of at-risk patients essential. The renal angina index (RAI) has been previously validated to predict severe AKI in heterogeneous populations of critically ill children. The performance of this score specifically in children with septic shock is unknown. Methods: A secondary analysis of a multicenter, prospective, observational study of 379 children with septic shock to determine the ability of the RAI to predict severe AKI at day 3, and to assess for the potential need for recalibration of the RAI in this unique subset of patients. Results: At the original cutoff of ≥8, the RAI predicted day 3 severe AKI with an area under the receiving operating characteristic (AUROC) curve 0.90 (95% confidence interval [CI]: 0.86 to 93), 95% sensitivity, and 54% specificity. A Youden's index identified a higher optimal cutoff of ≥20 (sensitivity 83%, specificity 80%), and day 1 platelet count <150 × 103/μl was an independent predictor of severe AKI (adjusted odds ratio: 3.2; 95% CI: 1.7 to 6.3; P < 0.001). Recalibration of the RAI to include platelet count and this new threshold restored the sensitivity of the original ≥8 threshold (95%), while improving its specificity (69%). Conclusions: The RAI appears to be a sensitive and reliable tool for prediction of severe AKI in children with septic shock, although the use of a recalibrated sepsis-specific RAI using a higher cutoff and platelet count may be beneficial.