Abstract: TH-PO115
A Modified Renal Angina Index Predicts Poor Outcomes After Pediatric Cardiac Surgery
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gist, Katja M., University of Colorado, Children''s Hospital Colorado, Aurora, Colorado, United States
- Soohoo, Megan, University of Colorado, Children''s Hospital Colorado, Aurora, Colorado, United States
- Krawczeski, Catherine, Nationwide Children's Hospital, Columbus, Ohio, United States
- Cooper, David S., Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States
- Mack, Emily, Childrens Hospital Colorado, Arvada, Colorado, United States
- Kwiatkowski, David M., Stanford University School of Mediicine, Palo Alto, California, United States
- Alten, Jeffrey, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States
- Basu, Rajit K., Children's Healthcare of Atlanta, Atlanta, Georgia, United States
Background
Children undergoing congenital cardiac surgery are at high risk for poor outcomes including those related to acute kidney injury (AKI), prolonged mechanical ventilation and death. Early adjudication of risk for poor outcome may identify opportunities for early mitigative or preventative actions We hypothesized modification of the renal angina index (RAI), a composite score of patient risk and early signs of renal dysfunction, for use in patients following cardiac surgery would predict AKI related poor patient outcomes.
Methods
The cRAI, combining risk factors and clinical signs of kidney dysfunction [Figure] was studied in a multicenter derivation analysis to compare predictive performance for poor outcome to prediction by the individual cRAI terms. Poor outcome was defined as Day 3 AKI or >5 days of mechanical ventilation or death.
Results
308 patients (64% male, med age 37 days (IQR:5-152 days) were analyzed. Half had single ventricle heart disease. The cRAI >10 outperformed individual and combination risk and injury factors for prediction of the composite outcome and demonstrated the optimal balance of sensitivity and specificity (AUC=0.77)[Table].
Conclusion
Derivation data indicates the cRAI, assessed soon after surgery, may optimize prediction for poor outcomes in children undergoing cardiac surgery. Future prospective studies are needed to validate the cRAI encompassing factors that may enhance its performance.
Table. Sensitivity analysis for individual and combination risk and injury factors
| Sensitivity (95% CI) | Specificity (95% CI) | Positive Predictive Value (95% CI) | Negative Predictive Value (95% CI) | Youden | |
| Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) > 2 | 97.75 (92.1-99.7) | 15.84 (11 .3-21.3) | 31.87 (30.5-33.3) | 94.59 (81.1-98.6) | 13.59 |
| Cardiopulmonary bypass (CPB) > 180 minutes | 21.35 (13.3-31.3) | 80.54 (74.7-85.6) | 30.65 (21.5-41.7) | 71.77 (69.2-74.2) | 1.89 |
| Vasoactive inotrope score at 8 hours (VIS-8) >15 | 33.71 (24.0-44.5) | 92.76 (88.5-95.8) | 65.22 (51.9-76.6) | 77.65 (74.9-80.2) | 26.47 |
| CPB>180 minutes + VIS-8>15 | 28.09 (19.1-38.6) | 97.29 (94.2-99.0) | 80.65 (63.9-90.8) | 77.06 (74.7-79.3) | 25.37 |
| Urine output (4-8 from ICU admission): <1 mL/kg/hr | 37.08 (27.1-47.9) | 69.68 (63.2-75.7) | 33.00 (26.0-40.8) | 73.33 (69.6-76.7) | 6.76 |
| Urine output (4-8): = 1-1.5 mL/kg/hr | 64.04 (53.2-73.9) | 39.82 (33.3-46.6) | 30.00 (26.2-34.1) | 73.33 (66.6-79.1) | 3.86 |
| Urine output (4-8): = 1.5-2 mL/kg/hr | 79.78 (69.9-87.6) | 23.08 (17.7-29.2) | 29.46 (26.9-32.2) | 73.91 (63.7-82.0) | 2.85 |
| Cardiac renal angina index positive (cRAI+) (10-40) | 58.43 (47.5-68.8) | 80.90 (75.2-85.9) | 55.32 (47.2-63.1) | 82.87 (78.9-86.2) | 39.42 |