Early prediction of pediatric acute kidney injury from the emergency department: A pilot study

Hanson, Holly R; Carlisle, Michael A.; Bensman, Rachel S.; Byczkowski, Terri; Depinet, Holly; Terrell, Tara; Pitner, Hilary; Knox, R. G.; Goldstein, Stuart L.; Basu, Rajit K.

doi:10.1016/j.ajem.2020.01.046

Cited by 12 publications

(7 citation statements)

References 33 publications

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Section: Discussionmentioning

confidence: 99%

“…The RAI score demonstrated 94% sensitivity and 99% NPV. Thus, it showed the importance of RAI as an emergency department tool to anticipate AKI and initiate early management(9). Similarly, an interesting study by Huang et al showed the use of RAI in septic shock pediatric patients, where 66 patients with septic shock were studied and analyzed to predict their likelihood of acquiring AKI within 3 days of the PICU admission.…”

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confidence: 99%

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Re-evaluating Renal Angina Index: An Authentic, Evidence-Based Instrument for Acute Kidney Injury Assessment: Critical Appraisal

et al. 2021

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Background/Introduction: Renal angina index (RAI) used to calculate and accurately predict risk for the development of acute kidney injury (AKI) has been heavily explored. AKI is traditionally diagnosed by an increase in serum creatinine (SCr) concentration or oliguria, both of which are neither specific nor sensitive, especially among children. An RAI score may be calculated by combining objective signs of kidney dysfunction (such as SCr) and patient context, such as AKI risk factors, thus potentially serving as a more accurate indicator for AKI.Objective: Due to the propitious and novel nature of RAI, this editorial commentary aims to analyze the current literature on RAI and determine how well RAI serves as a predictor of AKI outcomes.Method: A comprehensive literature search was conducted in PubMed/Medline and Google Scholar between January 2012 and July 2020. Literature included the prognostic aspect of early prediction of AKI in the pediatric and adult population via RAI.Results: The initial literature search included 149 studies, and a total of 10 studies reporting the outcomes of interest were included. The overall sample size across these studies was 11,026. The predictive ability of RAI had a pooled (95% CI) sensitivity of 79.21%, specificity of 73.22%, and negative predictive value of 94.83%.Conclusion: RAI shows benefit in the prediction of AKI among adult and pediatric populations. However, there is a lack of sufficient data, and further prospective studies are needed in pediatric populations to use RAI as a principal AKI indicator among clinicians.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Re-evaluating Renal Angina Index: An Authentic, Evidence-Based Instrument for Acute Kidney Injury Assessment: Critical Appraisal

et al. 2021

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“…The RAI model is still being improved to facilitate operation and improve detection accuracy. Hanson HR et al reported an acute RAI model for ruling out the development of in-hospital AKI at emergency department [23].…”

Section: Discussionmentioning

confidence: 99%

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

et al. 2020

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Background: Acute kidney injury (AKI) is independently related to the adverse outcome of septic shock, but it lacks effective early predictors. Renal anginal index (RAI) was used to predict subsequent severe AKI (AKIs) in critically ill patients. The application of RAI in children with septic shock has not been reported. This study aims to evaluate the efficacy of early RAI in predicting subsequent AKIs within 3 days after PICU admission in children with septic shock by comparing with early fluid overload (FO) and early creatinine elevation. Methods: Sixty-six children admitted to PICU aged 1 month to 16 years old, with septic shock from January 2016 to December 2019 were analyzed retrospectively. According to the 2012 Kidney Disease Improving Global outcomes (KDIGO) criteria, AKIs was defined by the KDIGO stage ≥2 within 3 days after PICU admission. Early RAI positive (RAI+) was defined as RAI ≥ 8 within 12 h of PICU admission. Any elevation of serum creatinine (SCr) over baseline within 12 h after PICU admission was denoted as "Early SCr > base". Early FO positive (FO+) was defined as FO > 10% within 24 h of PICU admission. Results: Of 66 eligible cases, the ratio of early RAI+, early SCr > base, early FO+ was 57.57, 59.09 and 16.67% respectively. The incidence of AKIs in early RAI+ group (78.94%) was higher than that in early RAI-group (21.42%) (p = 0.04), and there was no significant difference compared with the early FO+ group (71.79%) and early SCr > base group (81.82%) (P > 0.05). After adjustment for confounders, early RAI+ was independently associated with the occurrence of AKIs within 3 days (OR 10.04, 95%CI 2.39-42.21, p < 0.01). The value of early RAI+ (AUC = 0.78) to identify patients at high risk of AKIs was superior to that of early SCr > base (AUC = 0.70) and early FO+ (AUC = 0.58). A combination of serum lactate with early RAI+ improved the predictive performance for assessing AKIs (AUC = 0.83). Conclusions: Early RAI could be used as a more convenient and effective index to predict the risk of AKIs in children with septic shock within 3 days. Early RAI+ combined with serum lactate improved the predictive performance for assessing AKIs.

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“…In a very recently published study by Hanson et al the authors formulated an "Acute" RAI to be used in the ED setting, in a pilot study with 118 paediatric patients. The study found that their RAI had a negative predictive value of 99% and a sensitivity of 94%, suggesting that a negative RAI has the potential to rule out AKI in the ED setting [58]. the Curve, c-statistic) of 0.63.…”

Section: Abbasi Et Al Conducted a Systematic Review On The Predictionmentioning

confidence: 95%

Demystifying Renal Angina

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Early prediction of pediatric acute kidney injury from the emergency department: A pilot study

Cited by 12 publications

References 33 publications

Re-evaluating Renal Angina Index: An Authentic, Evidence-Based Instrument for Acute Kidney Injury Assessment: Critical Appraisal

Re-evaluating Renal Angina Index: An Authentic, Evidence-Based Instrument for Acute Kidney Injury Assessment: Critical Appraisal

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

Demystifying Renal Angina

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