Performance of renal angina index in predicting subsequent severe sepsis-associated acute kidney injury in children

Abstract

Objective : To determine the ability of renal angina index (RAI) in predicting subsequent severe sepsis-associated acute kidney injury (day3 S-AKI).

          Methods : The retrospective cross-sectional study of 234 eligible children, age 1 month to 15 years, who were admitted to Hatyai tertiary hospital PICU since 2014 to 2020. All of them were diagnosed severe sepsis or septic shock by Thai clinical practice guideline for management of pediatric severe sepsis and septic shock 2018 criteria. The RAI is a composition of risk strata and clinical signs of renal injury. On PICU admission date, we calculated RAI by positive RAI (RAI>8) called [ANG(+)]. On day3, we evaluated day3 S-AKI by using Kidney Disease Improving Global Outcomes (KDIGO) 2012 stage 2 and stage 3, respectively.

          Result : The prevalence of day3 S-AKI was 47.9%. The [ANG(+)] day3 S-AKI was 66.3% higher than the [ANG(-)] was 2.9% (p<0.001). The RAI>8 was independently associated with day3 S-AKI by diagnostic OR 60.2. The RAI presented a sensitivity of 98.2%, specificity of 54.1%, positive predictive value of 66.3% and negative predictive value of 97.1%. Prediction of day3 S-AKI by RAI had an AUC=0.76. The 30 days-mortality rate of S-AKI was 37.2%. The renal replacement therapy use was 14.2%.

Conclusions : The RAI is sensitive and feasible tool in predicting subsequent severe sepsis-associated acute kidney injury in children.