Renal angina index predicts fluid overload in critically ill children: an observational cohort study

Gorga, Stephen M; Carlton, Erin; Kohne, Joseph G.; Barbaro, Ryan P.; Basu, Rajit K.

doi:10.1186/s12882-021-02540-6

Cited by 8 publications

(11 citation statements)

References 40 publications

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“…Fluid overload is commonly associated with poor outcomes in critically ill pediatric patients with sepsis, with increased mortality, duration of mechanical ventilation, and hospital stay. 24,25 The RAI has shown an ability to predict the risk of developing fluid overload. 24 We believe that our study has a few limitations.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 The RAI has shown an ability to predict the risk of developing fluid overload. 24 We believe that our study has a few limitations. It is a study of a single referral center, which cares for children with complex pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we found that fluid overload significantly contributes to the change in RAI score in septic patients hospitalized in the PICU. Fluid overload is commonly associated with poor outcomes in critically ill pediatric patients with sepsis, with increased mortality, duration of mechanical ventilation, and hospital stay 24,25 . The RAI has shown an ability to predict the risk of developing fluid overload 24 …”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Renal Angina Index to Predict the Development of Acute Kidney Injury in Children With Sepsis Who Live in Middle-Income Countries

et al. 2023

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Objective: The renal angina index (RAI) provides a clinically feasible and applicable tool to identify critically ill children at risk of severe acute kidney injury (AKI) in high-income countries. Our objective was to evaluate the performance of the RAI as a predictor of the development of AKI in children with sepsis in a middle-income country and its association with unfavorable outcomes.Methods: This is a retrospective cohort study in children with sepsis hospitalized in the pediatric intensive care unit (PICU) between January 2016 and January 2020. The RAI was calculated 12 hours after admission to predict the development of AKI and at 72 hours to explore its association with mortality, the need for renal support therapy, and PICU stay. Results:We included 209 PICU patients with sepsis with a median age of 23 months (interquartile range, 7-60). We found that 41.1% of the cases (86/209) developed de novo AKI on the third day of admission (KDIGO 1, 24.9%; KDIGO 2, 12.9%; and KDIGO 3, 3.3%).Overall mortality was 8.1% (17/209), higher in patients with AKI (7.7% vs 0.5%, P < 0.01). The RAI on admission was able to predict the presence of AKI on day 3 (area under the curve (AUC), 0.87; sensitivity, 94.2%; specificity, 100%; P < 0.01), with a negative predictive value greater than 95%. An RAI greater than 8 at 72 hours was associated with a greater risk of mortality (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 2.0-3.2; P < 0.01), a need for renal support therapy (aOR, 2.9; 95% CI, 2.3-3.6; P < 0.01), and a PICU stay of more than 10 days (aOR, 1.54; 95% CI, 1.1-2.1; P < 0.01). Conclusions:The RAI on the day of admission is a reliable and accurate tool for predicting the risk of developing AKI on day 3, in critically ill children with sepsis in a limited resource context. A score greater than eight 72 hours after admission is associated with a higher risk of death, the need for renal support therapy, and PICU stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Renal Angina Index to Predict the Development of Acute Kidney Injury in Children With Sepsis Who Live in Middle-Income Countries

et al. 2023

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“…This group of patients is among the highest risk for significant fluid accumulation and the negative consequences of fluid overload. 31 We also found that mechanical ventilation alone demonstrated the highest accuracy among all patients, including those who were receiving no organ support. This may reflect that mechanical ventilation included those on chronic invasive mechanical ventilation and stable home-going ventilation, many of whom did not have IV access to receive IV fluids.…”

Section: Discussionmentioning

confidence: 54%

Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study

Gorga

SLIWICKI

Sturza

et al. 2022

J Pediatr Intensive Care

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Intravenous (IV) fluids are commonly administered to critically ill children, but clinicians lack effective guidance for the correct dose and duration of therapy resulting in variation of prescribing habits which harm children. It is unknown if clinicians recognize the amount of IV fluid that patients receive. We aimed to determine clinician's accuracy in the identification of the volume of IV fluids patients will receive over the next 24 hours. Prospective cohort study enrolled all patients admitted to the pediatric intensive care unit (PICU) from May to August 2021 at the University of Michigan's C.S. Mott Children's Hospital PICU. For each patient, clinicians estimated the volume of IV fluid that patients will receive in the next 24 hours. The primary outcome was accuracy of the estimation defined as predicted volume of IV fluids versus actual volume administered within 10 mL/kg or 500 mL depending on patient's weight. We tested for differences in accuracy by clinician type using chi-square tests. There were 259 patients for whom 2,295 surveys were completed by 177 clinicians. Clinicians' estimates were accurate 48.8% of the time with a median difference of 10 (1–26) mL/kg. We found that accuracy varied between clinician type: bedside nurses were most accurate at 64.3%, and attendings were least accurate at 30.5%. PICU clinicians have poor recognition of the amount of IV fluids their patients will receive in the subsequent 24-hour period. Estimate accuracy varied by clinician's role and improved over time, which may suggest opportunities for improvement.

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“…However, if the child's weight was 14 kg just 2 months ago at a well child visit and this was due to acute gastroenteritis, the definition of fluid overload at this point might not hold based on our common measurement methods (weight-based or metric-based) and the patients might reasonably be considered as a positive FB. There is not yet a standard approach to defining FB or fluid overload and from the nine pediatric-focused original research articles published from 2020 through March 2022 there were more than 12 different definitions with multiple additional combinations possible [ 2 ▪ , 3 , 4 ▪ , 5 ▪▪ , 6 , 7 ▪▪ , 8 , 9 ▪ , 10 ▪ ] (Table 1 ). The different definitions included metric vs. weight-based methods, considered different baseline (or anchor) weight, and different percentage thresholds (e.g., 10% vs. 20% vs. continuous).…”

Section: Fluid Balance and Fluid Overload: Definition And Measurementmentioning

confidence: 99%

Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)

Ricci

Bjornstad

2022

Current Opinion in Critical Care

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Purpose of reviewThe issues of fluid balance and fluid overload are currently considered crucial aspects of pediatric critically ill patients’ care.Recent findingsThis review describes current understanding of fluid management in critically ill children in terms of fluid balance and fluid overload and its effects on patients’ outcomes. The review describes current evidence surrounding definitions, monitoring, and treatment of positive fluid balance. In particular, the review focuses on specific patient conditions, including perioperative cardiac surgery, severe acute respiratory failure, and extracorporeal membrane oxygenation therapy, as the ones at highest risk of developing fluid overload and poor clinical outcomes. Gaps in understanding include specific thresholds at which fluid overload occurs in all critically ill children or specific populations and optimal timing of decongestion of positive fluid balance.SummaryCurrent evidence on fluid balance in critically ill children is mainly based on retrospective and observational studies, and intense research should be recommended in this important field. In theory, active decongestion of patients with fluid overload could improve mortality and other clinical outcomes, but randomized trials or advanced pragmatic studies are needed to better understand the optimal timing, patient characteristics, and tools to achieve this.

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Renal angina index predicts fluid overload in critically ill children: an observational cohort study

Cited by 8 publications

References 40 publications

Evaluation of the Renal Angina Index to Predict the Development of Acute Kidney Injury in Children With Sepsis Who Live in Middle-Income Countries

Evaluation of the Renal Angina Index to Predict the Development of Acute Kidney Injury in Children With Sepsis Who Live in Middle-Income Countries

Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study

Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)

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