Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children
Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children
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DOI：
10.1038/ki.2013.349
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发表时间：
2014-03-01
影响因子：
19.6
通讯作者：
Goldstein, Stuart L.
中科院分区：
文献类型：
--
作者：
Basu, Rajit K.;Zappitelli, Michael;Goldstein, Stuart L.
严重急性肾损伤（阿基）的可靠预测有可能优化治疗。在此，我们用肾性心绞痛指数（RAI）操作肾性心绞痛的经验概念，并确定RAI的预测性能。在进入儿科重症监护室时进行评估，72小时后（第3天阿基）评估随后的重度阿基（血清肌酐升高超过200%）。在一项多中心四队列评估（一次推导和三次验证）中，第0天RAI ≥ 8的发生率为15-68%，第3天阿基为13- 21%。在所有队列中，RAI ≥ 8的患者第3天阿基发生率较高，预测第3天阿基的RAI曲线下面积为0.74-0.81。对于第3天AKI，低于8的RAI具有高阴性预测值（92-99%）。RAI在预测第3天阿基方面优于传统的儿科疾病严重程度标志物（儿科死亡风险-II）和单独的阿基风险因素。此外，RAI在预测第3天阿基方面优于所有KDIGO分期。因此，我们通过推导和验证RAI来预测随后的严重阿基，从而将肾性心绞痛概念操作化。RAI提供了一种临床上可行且适用的方法，用于识别存在持续超过功能损伤的重度阿基风险的危重儿童。RAI可能通过识别进一步检测最有益的患者来减少反复无常的阿基生物标志物的使用。
Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive care unit, for subsequent severe AKI (over 200% rise in serum creatinine) 72 h later (Day-3 AKI). In a multicenter four cohort appraisal (one derivation and three validation), incidence rates for a Day 0 RAI of 8 or more were 15-68% and Day-3 AKI was 13-21%. In all cohorts, Day-3 AKI rates were higher in patients with an RAI of 8 or more with the area under the curve of RAI for predicting Day-3 AKI of 0.74-0.81. An RAI under 8 had high negative predictive values (92-99%) for Day-3 AKI. RAI outperformed traditional markers of pediatric severity of illness (Pediatric Risk of Mortality-II) and AKI risk factors alone for prediction of Day-3 AKI. Additionally, the RAI outperformed all KDIGO stages for prediction of Day-3 AKI. Thus, we operationalized the renal angina concept by deriving and validating the RAI for prediction of subsequent severe AKI. The RAI provides a clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. The RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.