Assessment of a modified renal angina index for AKI prediction in critically ill adults

Author:

Ortiz-Soriano Victor1,Kabir Shaowli2,Claure-Del Granado Rolando3ORCID,Stromberg Arnold2,Toto Robert D4,Moe Orson W4,Goldstein Stuart L5,Neyra Javier A14

Affiliation:

1. Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, KY, USA

2. Department of Statistics, University of Kentucky, Lexington, Kentucky, USA

3. School of Medicine, Universidad Mayor San Simon, Cochabamba, Bolivia

4. Department of Internal Medicine, Division of Nephrology, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA

5. Center for Acute Care Nephrology, Cincinnati Children’s Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA

Abstract

Abstract Background The renal angina index (RAI) is a useful tool for risk stratification of acute kidney injury (AKI) in critically ill children. We evaluated the performance of a modified adult RAI (mRAI) for the risk stratification of AKI in critically ill adults. Methods We used two independent intensive care unit (ICU) cohorts: 13 965 adult patients from the University of Kentucky (UKY) and 4789 from University of Texas Southwestern (UTSW). The mRAI included: diabetes, presence of sepsis, mechanical ventilation, pressor/inotrope use, percentage change in serum creatinine (SCr) in reference to admission SCr (ΔSCr) and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI Stage ≥2 at Days 2–7. Performance and reclassification metrics were determined for the mRAI score compared with ΔSCr alone. Results The mRAI score outperformed ΔSCr and readjusted probabilities to predict AKI Stage ≥2 at Days 2–7: C-statistic: UKY 0.781 versus 0.708 [integrated discrimination improvement (IDI) 2.2%] and UTSW 0.766 versus 0.696 (IDI 1.8%) (P < 0.001 for both). In the UKY cohort, only 3.3% of patients with mRAI score <10 had the AKI event, while 16.4% of patients with mRAI score of ≥10 had the AKI event (negative predictive value 96.8%). Similar findings were observed in the UTSW cohort as part of external validation. Conclusions In critically ill adults, the adult mRAI score determined within the first day of ICU admission outperformed changes in SCr for the prediction of AKI Stage ≥2 at Days 2–7 of ICU stay. The mRAI is a feasible tool for AKI risk stratification in adult patients in the ICU.

Funder

University of Texas Southwestern Medical Center O’Brien Kidney Research Core Center

University of Kentucky Center for Clinical and Translational Science

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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