Pediatric Department, Faculty of Medicine, Benha University, Egypt.
Pediatric Department, Al-Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
Medicine (Baltimore). 2023 Dec 22;102(51):e36713. doi: 10.1097/MD.0000000000036713.
Acute kidney damage (AKI) is a common cause of pediatric intensive care unit (PICU) admissions. Implementing a reno-protective strategy for AKI prediction can significantly enhance outcomes. The renal angina index (RAI) is a risk stratification tool used to predict severe AKI. We aim to assess the reliability and accuracy of the RAI scoring system in predicting AKI as compared to other conventional AKI markers. A prospective, observational study was conducted in the PICU of 2 tertiary medical centers in the Middle East. A total of 446 patients, aged 1-month to 14-years, without chronic kidney disease were enrolled. The RAI was calculated using the renal risk and renal injury score within the first 8 to 12 hours of admission. The accuracy of RAI was compared to changes in serum creatinine from baseline. The outcome was assessed on Day 3 for presence of AKI according to the kidney disease improving global outcome (KDIGO) criteria and associated sequelae. A positive RAI (RA+) was defined as RAI readings ≥ 8. Among the patients, 89 (19.9%) had a positive RAI within the first 8 to 12 hours of admission. The RA + group had a significantly higher occurrence of Day 3 severe AKI (KDIGO stages 2&3) compared to the RA- group (60.6% vs 4.2%, P < .001). The RA + group also had a significantly higher utilization of renal replacement therapy (RRT) (21.3% vs 1.1%, P < .001), longer mean PICU length of stay in days (11.1 ± 3.5 vs 5.5 ± 2.1, P < .001), and increased mortality (31.4% vs 2.8%, P < .001) compared to the RA- group. The RAI score demonstrated superior predictive ability for Day 3 AKI, with a sensitivity of 72%, specificity of 95%, and area under the curve (AUC) of 0.837, compared to changes in serum creatinine from baseline (sensitivity: 65%, specificity: 89%, AUC: 0.773), fluid overload (sensitivity: 43.7%, specificity: 79%, AUC: 0.613), and illness severity scores (sensitivity: 52.4%, specificity: 80.5%, AUC: 0.657). RAI proved to be a reliable and rapid bedside test for identifying critically ill children at risk of developing severe AKI. This enables physicians to implement reno-protective measures and intervene early, thereby improving prognosis.
急性肾损伤（AKI）是小儿重症监护病房（PICU）收治的常见原因。实施肾保护策略预测 AKI 可以显著改善预后。肾绞痛指数（RAI）是一种用于预测严重 AKI 的风险分层工具。我们旨在评估 RAI 评分系统在预测 AKI 方面的可靠性和准确性，与其他传统 AKI 标志物相比。这是一项在中东 2 家三级医疗中心的 PICU 进行的前瞻性、观察性研究。共纳入 446 名年龄在 1 个月至 14 岁、无慢性肾脏病的患者。RAI 是在入院后 8 至 12 小时内使用肾脏风险和肾脏损伤评分计算得出的。RAI 的准确性与基线时血清肌酐的变化进行了比较。根据肾脏疾病改善全球结局（KDIGO）标准和相关后遗症，在第 3 天评估 AKI 的发生情况。阳性 RAI（RA+）定义为 RAI 读数≥8。在这些患者中，89 例（19.9%）在入院后 8 至 12 小时内出现阳性 RAI。与 RA-组相比，RA+组第 3 天严重 AKI（KDIGO 分期 2&3）的发生率明显更高（60.6% vs 4.2%，P<0.001）。RA+组还明显更多地使用肾脏替代治疗（RRT）（21.3% vs 1.1%，P<0.001），重症监护病房住院时间的平均天数（11.1±3.5 vs 5.5±2.1，P<0.001），死亡率（31.4% vs 2.8%，P<0.001）也明显更高，与 RA-组相比。与基线时血清肌酐的变化相比，RAI 评分对第 3 天 AKI 的预测能力更优，其灵敏度为 72%，特异性为 95%，曲线下面积（AUC）为 0.837（灵敏度：65%，特异性：89%，AUC：0.773），液体超负荷（灵敏度：43.7%，特异性：79%，AUC：0.613）和疾病严重程度评分（灵敏度：52.4%，特异性：80.5%，AUC：0.657）。RAI 被证明是一种可靠且快速的床边检测方法，可用于识别有发生严重 AKI 风险的危重症儿童。这使医生能够实施肾保护措施并尽早进行干预，从而改善预后。
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