Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Ren Fail. 2023 Dec;45(1):2205958. doi: 10.1080/0886022X.2023.2205958.
The renal angina index (RAI) is a tool that has been validated by several studies in the pediatric population to predict the development of severe acute kidney injury (AKI). The aims of this study were to evaluate the efficacy of the RAI in predicting severe AKI in critically ill patients with COVID-19 and to propose a modified RAI (mRAI) for this population.
This was a prospective cohort analysis of all COVID-19 patients receiving invasive mechanical ventilation (IMV) who were admitted to the intensive care unit (ICU) of a third-level hospital in Mexico City from 03/2020 to 01/2021. AKI was defined according to KDIGO guidelines. The RAI score was calculated for all enrolled patients using the method of Matsuura. Since all patients had the highest score for the condition (due to receiving IMV), the score corresponded to the delta creatinine (ΔSCr) value. The main outcome was severe AKI (stage 2 or 3) at 24 and 72 h after ICU admission. A logistic regression analysis was applied to search for factors associated with the development of severe AKI, and the data were applied to develop a mRAI and compare it the efficacy of both scores (RAI and mRAI).
Of the 452 patients studied, 30% developed severe AKI. The original RAI score was associated with AUCs of 0.67 and 0.73 at 24 h and 72 h, respectively, with a cutoff of 10 points to predict severe AKI. In the multivariate analysis adjusted for age and sex, a BMI ≥30 kg/m, a SOFA score ≥6, and Charlson score were identified as risk factors for the development of severe AKI. In the new proposed score (mRAI), the conditions were summed and multiplied by the ΔSCr value. With these modifications, the AUC improved to 0.72 and 0.75 at 24 h and 72 h, respectively, with a cutoff of 8 points.
The original RAI is a limited tool for patients with critical COVID-19 receiving IMV. The mRAI, with the parameters proposed in the present study, improves predictive performance and risk stratification in critically ill patients receiving IMV.
肾绞痛指数（RAI）是一种已被多项儿科研究验证的工具，用于预测严重急性肾损伤（AKI）的发生。本研究旨在评估 RAI 在预测 COVID-19 危重症患者严重 AKI 中的疗效，并为该人群提出改良的 RAI（mRAI）。
这是一项对所有接受有创机械通气（IMV）的 COVID-19 患者的前瞻性队列分析，这些患者于 2020 年 3 月至 2021 年 1 月期间入住墨西哥城三级医院的重症监护病房（ICU）。AKI 根据 KDIGO 指南定义。对所有入组患者采用松浦法计算 RAI 评分。由于所有患者的最高评分均为接受 IMV，因此评分对应于肌酸酐差值（ΔSCr）值。主要结局为 ICU 入院后 24 和 72 小时发生严重 AKI（第 2 或 3 期）。应用逻辑回归分析寻找与严重 AKI 发生相关的因素，并将数据应用于开发 mRAI 并比较两个评分（RAI 和 mRAI）的疗效。
在 452 例研究患者中，30%发生严重 AKI。原始 RAI 评分在 24 小时和 72 小时时的 AUC 分别为 0.67 和 0.73，截断值为 10 分以预测严重 AKI。在调整年龄和性别后的多变量分析中，BMI≥30kg/m、SOFA 评分≥6 和 Charlson 评分被确定为严重 AKI 发生的危险因素。在新提出的评分（mRAI）中，将条件相加并乘以 ΔSCr 值。通过这些修改，24 小时和 72 小时时的 AUC 分别提高至 0.72 和 0.75，截断值为 8 分。
对于接受 IMV 的危重症 COVID-19 患者，原始 RAI 是一种有限的工具。mRAI 采用本研究提出的参数，可提高接受 IMV 的危重症患者的预测性能和风险分层。
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