The following is a summary of “External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock,” published in the November 2023 issue of Critical Care by Stanski et al.
Acute kidney injury (AKI) is a common and serious complication of pediatric septic shock, increasing morbidity and mortality. Researchers started a retrospective study to evaluate the performance of a modified renal angina index (sRAI) in a separate cohort to validate its ability to predict severe AKI in children with septic shock.
They conducted a secondary analysis, multicenter, observational study involving children with septic shock admitted to the pediatric intensive care unit (January 2019 to December 2022). Severe acute kidney injury (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI) was the primary outcome. The predictive performance of the sRAI (calculated on Day 1) was compared to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). RAI + is RAI ≥ 8, while sRAI + is RAI ≥ 20 or RAI 8 to < 20 with platelets < 150 × 10<sup style=”vertical-align: sup;”>3</sup>µL.
The results showed 22% (79 out of 363) of patients experienced D3 severe AKI. Of the total, 39% (140) were sRAI + , 54% (195) RAI + , and 70% (253) had D1 SCr > Baseline + . In comparison to sRAI-, sRAI + was associated with a 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 exhibited predictive value for D3 severe AKI with an AUROC of 0.86 (95%CI 0.82–0.90), demonstrating higher specificity (74%) compared to D1 SCr > Baseline (36%) and RAI + (58%). In the multivariable regression analysis, sRAI + maintained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0–10.2, P<0.001) and the need for KRT (aOR 5.6, 95%CI 1.5–21.5, P=0.01).
They concluded that sRAI was more accurate and specific than context-free SCr elevation or the original RAI in predicting severe AKI in pediatric septic shock.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04746-6