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Abstract: FR-PO004

Validation of a Modified Renal Angina Index (RAI) in Critically Ill Patients With COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Del Toro-Cisneros, Noemi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Berman, Nathan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Pérez, Adela Uribe, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Hernandez Flores, John, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Caballero-Islas, Adrián Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
Background

The renal angina index (RAI) is a tool validated in multiple studies in pediatric and adult populations, to predict the development of severe AKI. The aim of this study was to evaluate the efficacy of the RAI in predicting severe AKI in critically ill patients with COVID-19 and to validate a modified model.

Methods

Prospective cohort analysis of all COVID-19 patients with invasive mechanical ventilation (IMV), admitted to the intensive care unit (ICU) of our Institute in Mexico City from 03/2020 to 01/202. AKI was defined according to KDIGO guidelines. Patients with CKD stages 4 or 5 or AKI on admission were excluded. RAI was calculated using the method of Matsuura et al (Figure 1). Outcome was defined as the development of severe AKI (stage 2 or 3) at 24 and 72 hours after ICU admission. Since all patients had 5 points corresponding to IMV, we performed a logistic regression analysis to look other factors associated with the severe AKI and with them development a modified RAI (mRAI) and compared the efficacy of both scores.

Results

Of the 452 patients, 30% developed severe AKI. Fig 1 shows the performance of the RAI to predict the development of severe AKI, with an AUC of 0.67 at 24 h and AUC of 0.73 at 72 h. In a multivariate analysis, adjusted for age and sex, we obtained BMI ≥30 kg/m2, SOFA ≥6, and Charlson Index as risk factors for development of the outcome (Table 1). In the new proposed score (mRAI), the conditions were summed and multiplied by the Cr delta (Figure 1).

Conclusion

The original RAI in patients with critical COVID-19 with IMV is a limited tool. The modified score (mRAI) adds predictive performance and improves risk stratification in critically ill patients with IMV.