Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Room T6.243, Cincinnati, OH, 45229-3039, USA.
Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Nephrol. 2019 Oct;34(10):1777-1784. doi: 10.1007/s00467-019-04294-8. Epub 2019 Jul 8.
The Renal Angina Index (RAI) is a validated screening tool used at 12 h of pediatric intensive care unit (PICU) admission to predict severe acute kidney injury (AKI) on day 3 of PICU stay. A measured or height-imputed baseline serum creatinine (SCr) is required for AKI diagnosis and RAI calculation, yet these are often lacking. We assessed an age-based, height-independent baseline SCr calculation and compared the RAI values employing this method to their historical counterpart.
An electronic algorithm was implemented to generate RAI score for patients admitted to our PICU. We reviewed 157 consecutive patient records from May 2017, until we cumulated 100 with a valid RAI calculation. We compared RAI scores using the age-based SCr imputation method of Pottel to the historical RAI. Our primary outcome was a difference in the rate of RAI fulfillment (≥ 8) reclassification between methods.
Of the first 100 patients, 27 had measured baseline SCr and 73 used height imputation. Only two patients had RAI reclassified with the Pottel method (one in each direction). Being small for age or older were associated with ≥ 25% overestimation of the baseline SCr in 20 patients with the Pottel method compared with height imputation. 15/157 patients had a falsely positive RAI due to lack of measured baseline SCr and height.
The age-based method to estimate baseline SCr offers a viable height-independent alternative for RAI calculation. While less precise than a height-based approach, this lack of precision rarely leads to reclassification of patient RAI status.
肾绞痛指数（RAI）是一种经过验证的筛选工具，用于在儿科重症监护病房（PICU）入院后 12 小时预测 PICU 住院第 3 天发生严重急性肾损伤（AKI）。AKI 诊断和 RAI 计算需要测量或身高推断的基线血清肌酐（SCr），但这些通常是缺乏的。我们评估了一种基于年龄、与身高无关的基线 SCr 计算方法，并比较了使用该方法的 RAI 值与其历史对应值。
我们实施了一个电子算法，为入住我们 PICU 的患者生成 RAI 评分。我们回顾了 2017 年 5 月至 2017 年 5 月期间连续 157 例患者的记录，直到累积了 100 例具有有效 RAI 计算的患者。我们比较了使用 Pottel 年龄-based SCr 推断方法的 RAI 评分与历史 RAI。我们的主要结局是两种方法之间 RAI 满足率（≥8）的重新分类差异。
在最初的 100 例患者中，27 例有测量的基线 SCr，73 例使用身高推断。只有两名患者使用 Pottel 方法重新分类（各有一个）。与身高推断相比，使用 Pottel 方法的 20 例患者中，有 27 例患者年龄较小或年龄较大，其基线 SCr 估计值高估了≥25%。由于缺乏测量的基线 SCr 和身高，15/157 例患者的 RAI 呈假阳性。
基于年龄的估计基线 SCr 方法为 RAI 计算提供了一种可行的、与身高无关的替代方法。虽然不如基于身高的方法精确，但这种不精确性很少导致患者 RAI 状态的重新分类。
