• Crit Care · Nov 2023

    Multicenter Study Observational Study

    External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock.

    • Natalja L Stanski, Rajit K Basu, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Lakhmir S Chawla, and Stuart L Goldstein.
    • Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 2005, Cincinnati, OH, 45229, USA. natalja.stanski@cchmc.org.
    • Crit Care. 2023 Nov 28; 27 (1): 463463.

    BackgroundAcute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, to improve specificity in this population (sRAI). Here, we prospectively assess sRAI performance in a separate cohort.MethodsA secondary analysis of a prospective, multicenter, observational study of children with septic shock admitted to the pediatric intensive care unit from 1/2019 to 12/2022. The primary outcome was severe AKI (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI), and we compared predictive performance of the sRAI (calculated on Day 1) to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). Original renal angina fulfillment (RAI +) was defined as RAI ≥ 8; sepsis renal angina fulfillment (sRAI +) was defined as RAI ≥ 20 or RAI 8 to < 20 with platelets < 150 × 103/µL.ResultsAmong 363 patients, 79 (22%) developed D3 severe AKI. One hundred forty (39%) were sRAI + , 195 (54%) RAI + , and 253 (70%) D1 SCr > Baseline + . Compared to sRAI-, sRAI + had higher risk of D3 severe AKI (RR 8.9, 95%CI 5-16, p < 0.001), kidney replacement therapy (KRT) (RR 18, 95%CI 6.6-49, p < 0.001), and mortality (RR 2.5, 95%CI 1.2-5.5, p = 0.013). sRAI predicted D3 severe AKI with an AUROC of 0.86 (95%CI 0.82-0.90), with greater specificity (74%) than D1 SCr > Baseline (36%) and RAI + (58%). On multivariable regression, sRAI + retained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0-10.2, p < 0.001) and need for KRT (aOR 5.6, 95%CI 1.5-21.5, p = 0.01).ConclusionsPrediction of severe AKI in pediatric septic shock is important to improve outcomes, allocate resources, and inform enrollment in clinical trials examining potential disease-modifying therapies. The sRAI affords more accurate and specific prediction than context-free SCr elevation or the original RAI in this population.© 2023. The Author(s).

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