Renal angina index for early identification of risk of acute kidney injury in critically ill children.

Abstract

The main objective was to test whether the Renal Angina Index (RAI), calculated on patient admission to the pediatric intensive care unit (PICU), is associated with the risk of acute kidney injury (AKI) based on the Kidney Disease: Improving Global Outcomes (KDIGO) (stage ≥ 2) in 72h. The specific aim was to analyze the performance of the RAI at a specialized oncology PICU. Retrospective cohort study involving two pediatric intensive care units located within a general hospital and an oncology hospital. Children aged ≥ 3months to < 18years admitted to the intensive care units in 2017 with a length of stay ≥ 72h were included. The sample included 249 patients, of which 51% were male (127 patients), with median age of 77months, and mean ICU stay of 5days. Of the total admissions, 141 were clinical (57%) and 108 surgical. The rate of AKI was 15% and death rate within 30days was 13%. Having a positive RAI on admission showed a statistically significant association with AKI at Day 3 (OR = 18.5, 95%CI = 4.3 - 78.9, p < 0.001) and with death (OR = 3.9, 95%CI = 1.6 - 9.9, p = 0.004). The accuracy of the RAI in the cancer population was 0.81 on the ROC curve (95%CI 0.74, 0.88). The RAI is a useful tool for predicting AKI and death in critically ill children, including in oncology units.