Abstract
Background
Identifying acute kidney injury (AKI) early can inform medical decisions key to mitigation
of injury. An AKI risk stratification tool, the renal angina index (RAI), has proven
better than creatinine changes alone at predicting AKI in critically ill children.
Objective
To derive and test performance of an “acute” RAI (aRAI) in the Emergency Department
(ED) for prediction of inpatient AKI and to evaluate the added yield of urinary AKI
biomarkers.
Methods
Study of pediatric ED patients with sepsis admitted and followed for 72 h. The primary
outcome was inpatient AKI defined by a creatinine >1.5× baseline, 24–72 h after admission.
Patients were denoted renal angina positive (RA+) for an aRAI score above a population
derived cut-off. Test characteristics evaluated predictive performance of the aRAI
compared to changes in creatinine and incorporation of 4 urinary biomarkers in the
context of renal angina were assessed.
Results
118 eligible subjects were enrolled. Mean age was 7.8 ± 6.4 years, 16% required intensive
care admission. In the ED, 27% had a +RAI (22% had a >50% creatinine increase). The
aRAI had an AUC of 0.92 (0.86–0.98) for prediction of inpatient AKI. For AKI prediction,
RA+ demonstrated a sensitivity of 94% (69–99) and a negative predictive value of 99%
(92–100) (versus sensitivity 59% (33–82) and NPV 93% (89–96) for creatinine ≥2× baseline).
Biomarker analysis revealed a higher AUC for aRAI alone than any individual biomarker.
Conclusions
This pilot study finds the aRAI to be a sensitive ED-based tool for ruling out the
development of in-hospital AKI.
Abbreviations:
AKI (Acute Kidney Injury), aRAI (acute Renal Angina Index), ED (Emergency Department), IL-18 (Interleukin 18), KDIGO (Kidney Disease Improving Global Outcomes), KIM-1 (kidney injury molecule-1), L-FABP (liver fatty acid binding protein), NGAL (neutrophil gelatinase-associated lipocalin), RA (Renal Angina), RAI (Renal Angina Index), SCr (serum creatinine)Keywords
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Article Info
Publication History
Published online: January 27, 2020
Accepted:
January 26,
2020
Received in revised form:
January 15,
2020
Received:
October 8,
2019
Identification
Copyright
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