Abstract: SA-PO141
Assessment of Renal Angina Index for the Prediction of Severe AKI in Critically Ill Adults
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - III
November 09, 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
- Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
- Ortiz-Soriano, Victor M., University of Kentucky, Lexington, Kentucky, United States
- Kabir, Shaowli, University of Kentucky, Lexington, Kentucky, United States
- Claure-Del Granado, Rolando, Hospital Obrero #2 - C.N.S.; Universidad Mayor de San Simon, School of Medicine, Cochabamba, Cercado, Bolivia, Plurinational State of
- Stromberg, Arnold James, University of Kentucky, Lexington, Kentucky, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background
Risk-stratification tools of incident AKI in critically ill adults are needed. The renal angina index (RAI) was developed and validated in the pediatric population. We evaluated the performance of the RAI for the prediction of severe AKI in critically ill adults.
Methods
A cohort of 12,084 patients admitted to the ICU at the University of Kentucky (2009-2017) was utilized. Inclusion criteria consisted of age ≥18, ICU stay ≥3 days, at least 2 serum creatinine (SCr) measures in the first 2 days of ICU stay and one measure at 3-7 days of stay. Exclusion criteria consisted of ESKD, kidney transplant or baseline eGFR <15. A modified RAI (mRAI) included risk level criteria 1) mechanical ventilation or vasoactive drug support, 2) sepsis, and 3) diabetes and injury level criteria of 1) SCr increments (<25%, 25-49%, 50-99%, ≥100) and 2) fluid overload (FO%, <5%, 5-10%, 11-19%, ≥20%). Performance metrics were used for evaluation of components of the mRAI in reference to isolated changes in SCr.
Results
Mean (SD) age was 57.3 (16.5), 42% were women and 90% white. Mean (SD) SOFA score was 5.2 (3.0). The incidence of AKI (KDIGO-SCr) stage ≥2 at 3-7 days of ICU stay was 15.7%. Median [IQR] mRAI (determined in the first 2 days of ICU stay) was 24 [8-40] vs 10 [5-40], p<0.001 for those with vs without AKI stage ≥2 at 3-7 days. Performance metrics are reported in Table. Similar performance was observed when the cohort was restricted to patients without AKI or AKI stage ≤1 in the first 2 days of ICU stay.
Conclusion
When compared with examination of isolated changes in SCr, components of the mRAI exhibited better performance for the prediction of severe AKI in critically ill adults, particularly when measured baseline SCr was not available. The mRAI is a feasible risk-stratification tool that needs validation in the adult population.
Performance metrics (95%CI) of components of the mRAI for the prediction of AKI stage ≥2 in critically ill adults
| ΔSCr first 2 days of ICU stay | mRAI using ΔSCr first 2 days of ICU stay | ΔSCr first 2 days of ICU stay (ref: measured baseline) | mRAI using ΔSCr first 2 days of ICU stay (ref: measured baseline) | |
| AUC | 0.59 (0.58, 0.60) | 0.70 (0.69, 0.72)* | 0.85 (0.84, 0.87) | 0.87 (0.85, 0.88)* |
| Absolute IDI | ref | 0.05 (0.04, 0.05)* | ref | 0.01 (0.002, 0.01)* |
*p<0.001 for performance comparison to corresponding reference; AUC = area under the receiving operating characteristic curve; IDI = integrated discrimination index; SCr = serum creatinine