#699 Diagnostic accuracy of the Modified Renal Angina Index (mRAI) for predicting acute kidney injury among critically ill Filipino adults

Abstract

Abstract Background and Aims The proposed mRAI (modified renal angina index) (Fig. 1) predicts moderate to severe AKI within the first 7 days of ICU stay which outperforms serum creatinine and urine output. The use of the mRAI in AKI may be warranted to improve predicted performance of AKI biomarkers. The study aims to evaluate the diagnostic accuracy of modified renal angina index in predicting Acute Kidney Injury (AKI) among Critically ill Adult Filipino patient in a Tertiary Institution and its association with in hospital MAKE (Major Adverse Kidney Events). Method A retrospective cohort study including all adult critically ill patients, they were dichotomized into “low” (<10) or “high risk” (>10) based on the mRAI score upon the 1st ICU admission (Day 0-24 hr) during the hospital stay. Inclusion criteria: age >18 years old, ICU patients between 2019-2022. Exclusion criteria: Chronic Kidney Disease (Egfr <30 ml/min), Transplant recipients, HIV/Cancer, <48 hrs ICU stay, little changes in creatinine (<2x from baseline between Day 0-24 hr ICU admission). The composite outcome is achieved if at least one is met during the index of hospitalization: All-cause mortality prior to discharge or after ICU admission, New onset of renal replacement therapy (RRT), persistent renal dysfunction. The sensitivity, specificity, predictive values and area under the curve is used to determine diagnostic accuracy of the mRAI Scoring and its association with in Hospital MAKE. Simple and multiple logistic regression analysis is used to control the effect of confounders in determining the association of mRAI to AKI. SPSS version 20 will be used in the analysis. Results Using a cut off score of 10, the mRAI show 84.29% sensitivity, 76.06% specificity, 77.63%, PPV 83.08% NPV 80.14% and AUC 80.14% in predicting moderate to severe AKI (Fig. 2). A mRAI of >10 is associated with in hospital MAKE showing a 97.14% sensitivity, 67.61% specificity, 74.73% PPV, 96.0% NPV, and AUC 82.27% (Fig. 3). Among the high risk group there were 68 (97.1%) who had MAKE, 62 (88.6%) new onset RRT, 12% (17.1%) died within 7 days of ICU admission, 64 (91.4%) persistent renal dysfunction (Fig. 4). Conclusion The proposed score can be applied among critically ill adult Filipino patients which is an easy bedside tool for identification of moderate to severe AKI. mRAI constitutes a sensitive test with a high negative predictive, affirming its capability being a screening test, complementary to laboratory parameters and clinical judgement. We also found out that a mRAI score of >10 is associated with In-Hospital Major Adverse Kidney Events.