Assessment of a modified renal angina index for AKI prediction in critically ill adults

摘要

Background The renal angina index (RAI) is a useful tool for risk stratification of acute kidney injury (AKI) in critically ill children. We evaluated the performance of a modified adult RAI (mRAI) for the risk stratification of AKI in critically ill adults. Methods We used two independent intensive care unit (ICU) cohorts: 13 965 adult patients from the University of Kentucky (UKY) and 4789 from University of Texas Southwestern (UTSW). The mRAI included: diabetes, presence of sepsis, mechanical ventilation, pressor/inotrope use, percentage change in serum creatinine (SCr) in reference to admission SCr (Delta SCr) and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI Stage >= 2 at Days 2-7. Performance and reclassification metrics were determined for the mRAI score compared with Delta SCr alone. Results The mRAI score outperformed Delta SCr and readjusted probabilities to predict AKI Stage >= 2 at Days 2-7: C-statistic: UKY 0.781 versus 0.708 integrated discrimination improvement (IDI) 2.2 and UTSW 0.766 versus 0.696 (IDI 1.8) (P = 10 had the AKI event (negative predictive value 96.8). Similar findings were observed in the UTSW cohort as part of external validation. Conclusions In critically ill adults, the adult mRAI score determined within the first day of ICU admission outperformed changes in SCr for the prediction of AKI Stage >= 2 at Days 2-7 of ICU stay. The mRAI is a feasible tool for AKI risk stratification in adult patients in the ICU.