Journal Article

External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock

Haileselassie, Bereketeab, Weiss, Scott L., Zingarelli, Basilia, Lutfi, Riad, Bigham, Michael T., Baines, Torrey, Thomas, Neal J., Kaplan, Jennifer, Goldstein, Stuart L., Lautz, Andrew J., Schwarz, Adam J., Jain, Parag N., Fitzgerald, Julie C., Stanski, Natalja L., Cvijanovich, Natalie Z., Standage, Stephen W., Atreya, Mihir R., Basu, Rajit K., Chawla, Lakhmir S.

2023

Overview

Background Acute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, to improve specificity in this population (sRAI). Here, we prospectively assess sRAI performance in a separate cohort. Methods A secondary analysis of a prospective, multicenter, observational study of children with septic shock admitted to the pediatric intensive care unit from 1/2019 to 12/2022. The primary outcome was severe AKI (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI), and we compared predictive performance of the sRAI (calculated on Day 1) to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). Original renal angina fulfillment (RAI +) was defined as RAI ≥ 8; sepsis renal angina fulfillment (sRAI +) was defined as RAI ≥ 20 or RAI 8 to < 20 with platelets < 150 × 10 3 /µL. Results Among 363 patients, 79 (22%) developed D3 severe AKI. One hundred forty (39%) were sRAI + , 195 (54%) RAI + , and 253 (70%) D1 SCr > Baseline + . Compared to sRAI-, sRAI + had higher risk of D3 severe AKI (RR 8.9, 95%CI 5–16, p  < 0.001), kidney replacement therapy (KRT) (RR 18, 95%CI 6.6–49, p  < 0.001), and mortality (RR 2.5, 95%CI 1.2–5.5, p  = 0.013). sRAI predicted D3 severe AKI with an AUROC of 0.86 (95%CI 0.82–0.90), with greater specificity (74%) than D1 SCr > Baseline (36%) and RAI + (58%). On multivariable regression, sRAI + retained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0–10.2, p  < 0.001) and need for KRT (aOR 5.6, 95%CI 1.5–21.5, p  = 0.01). Conclusions Prediction of severe AKI in pediatric septic shock is important to improve outcomes, allocate resources, and inform enrollment in clinical trials examining potential disease-modifying therapies. The sRAI affords more accurate and specific prediction than context-free SCr elevation or the original RAI in this population.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Acute Kidney Injury - diagnosis / Acute Kidney Injury - etiology / Acute renal failure / Angina pectoris / Care and treatment / Child / Children / Complications and side effects / Critical care / Critical Care Medicine / Emergency Medicine / Health aspects / Humans / Injuries / Intensive / Kidney diseases / Medical prognosis / Medicine / Medicine & Public Health / Mortality / Patients / Pediatric intensive care / Pediatrics / Personalized medicine in the ICU / Precision medicine / Prevention / Prospective Studies / Regression analysis / Risk factors / Sepsis / Sepsis - complications / Septic shock / Severity of Illness Index / Shock, Septic - complications / Ventilators